![]() 23 proposed the double centrifugation technique, including the first centrifugation to separate the erythrocyte layer and the second centrifugation after collecting the upper plasma layer without the leukocyte layer (buffy coat). The supernatant PRP was transferred from the larger outer syringe into the small inner syringe and ready for use. 13, using a commercial PRP kit, the single centrifugation technique was performed to separate the red blood cell from the other parts of the plasma. The preparation of LP-PRP varies in terms of the number of centrifugation, the speed of centrifugation, and the type of collection tube. ![]() The leukocyte-poor PRP (LP-PRP), a plasma preparation that has a high number of platelet cells with a low number of white blood cells, is an optional PRP for the treatment of knee OA to avoid mediating pro-inflammatory effect of white blood cells after the injection in knee OA 13, 21, 22. However, major guidelines do not include or recommend against the use of PRP for the treatment of knee OA 3, 5. Some studies reported that PRP injection for knee OA provided better pain relief and improved functional outcomes than placebo control, hyaluronic acid (HA), or steroid injection 18, 19, 20. Studies regarding PRP applied in knee OA showed that it improved patient's clinical outcomes by releasing several growth factors and cytokines, promoting reparation and minimization of the inflammation occurring in the process of degenerative arthritis 7, 8, 12, 13, 14, 15, 16, 17. However, there are variations of PRP in current use, including volume of collected blood 8, number centrifugation of PRP preparation 9, 10, platelet activation before injection 12, number of injection, and interval between each injection 7. The platelet-rich plasma (PRP), a biologic product prepared from autologous blood, has become an attractive option for the non-surgical treatment of knee OA 7, 8, 9, 10, 11, 12. However, in mild to moderate knee OA, non-surgical treatment options are in good agreement between physicians and patients with a wide diversity of results reported in the literature 2, 3, 4, 6. Therefore, recommended methods range from non-surgical to surgical treatments 2, 3, 4, 5, 6. Treatment options are based on the stage of the disease, the patient's condition, and available medical facilities. Knee osteoarthritis (OA) is a significant degenerative joint disease affecting patients' quality of life and daily functions 1. In conclusion, two- or four-PRP intra-articular injection at a 6-week interval for knee OA demonstrated no changes of synovial cytokines and growth factors but similarly improved clinical outcomes from 6 weeks until 1 year. Both groups had significantly improved clinical outcomes from six weeks including visual analog scale (VAS), patient-reported outcome measures, with a significant delayed improvement of performance-based measures. ![]() There were no changes of synovial inflammatory cytokines (IL-1β, IL-6, IA-17A, and TNF-alpha), anti-inflammatory cytokines (IL-4, IL-10, IL-13, and IL-1RA), and growth factors (TGF-B1, VEGF, PDGF-AA, and PDGF-BB) between baseline levels and six weeks in group A, and 18 weeks in group B. The average platelet count and white blood cell count in PRP were 430,000/µL and 200/ µL, respectively. There were no differences in mean age, gender, body mass index (BMI), and radiographic OA grading. Ninety-four patients who had completed synovial fluid collection were included for final evaluation, 51 in group A and 43 in group B. Changes in synovial biomarkers were compared with the baseline levels of both groups, and clinical outcomes were evaluated until one year. Patients were divided into two or four intra-articular PRP injections (group A and B, respectively). Before each PRP injection, synovial fluid aspiration was collected for investigation. One hundred twenty-five patients having knee osteoarthritis (OA) underwent PRP injections at a 6-week interval. We compared two and four intra-articular injections of platelet-rich plasma (PRP) in terms of changes of synovial cytokines and clinical outcomes.
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