Platelet Rich Plasma Versus Steroid Injections For Knee Arthritis

*The Real Hidden Conclusion In This 2025 Level 1 Study Comparing Steroid to Platelet Rich Plasma*
This month (3/2025) the Journal of Arthroplasty published a level 1 research paper comparing PRP injections to corticosteroid injections for patients with KL2/3 knee osteoarthritis. The authors' conclusion? Steroid injection gives better pain relief than PRP injection at 6 weeks and BOTH steroid and PRP were not effective at 3 months. On initial review, a conclusion that steroid might be better for pain relief is actually not that surprising since the benefits of PRP continue to improve over 3 months. This would be like a level 1 paper concluding that 2% lidocaine gives better pain relief than corticosteroid at 15 minute followup. But there is more information to learn from this paper just published. I applaud the authors' efforts but it does seem that there are often institutional restrictions limiting biological research in many published papers today. This paper had a non standardized blood draw to make PRP. There is a huge difference in dose between 30cc and 60cc of blood and in this paper we do not know the average blood draw volume in the N=52 patients in this trial. There was no quantification of average starting platelet count in whole blood or the platelets in the PRP. They report using the Isto Magellan system to make PRP...which is helpful since we have some idea of the platelet concentrating ability (2.8x to 4.9x in published literature). However, the authors also report only injecting 3cc of PRP made from this system for these patients with KL2/3 knee OA...... a volume that I think is not typical in today's regenerative medicine practice unless there is some reason to hyperconcentrate the PRP in a two spin system to lower the end volume.
For example, if a patient in this study had a 30cc blood draw from which 3 cc PRP was made on the Magellan..... assuming 200 platelet count and a generous 5x concentrating ability....then 3 billion platelets was delivered. The RESTORE and PEAK trials both showed that even in a 3 injection protocol this 3 billion platelet dose does NOT work to significantly help patients with knee OA. The authors of this just published study found the exact same thing....at three months the 52 patients in this study had no significant benefit. Of note....we cannot ignore the fact that the patients that got steroid injections ALSO were no better by 3 months....so they had all the risks of steroid and known catabolic effects from steroid for no clinical benefit at the 3 month mark.....a huge negative in my opinion that must be disclosed to patients in the informed consent when discussing treatment options.
At Texas Orthobiologics we do not use low dose PRP because evidence shows that it does not reliably help patients old enough to have KL2/3 osteoarthritis. We can help more people more predictably by simply drawing more blood and using a PRP system that can recover at least 60% of the platelets.