As an autologous blood derivative, the platelets concentrated plasma protein is also known as platelet-rich plasma (PRP). It has been used in various medical fields involving skin to eye diseases and orthopedic surgery, with the aim of stimulating tissue healing through platelet-derived growth factor medium and other bioactive molecules. Platelet cells contain more cytokines and growth factors (GF) that can stimulate growth and duplication of cells, regeneration of tissues and collagen production. PRP injection provides a high level of these stimulants to the damaged tissue and helps regeneration. Conservative treatment has alleged scientifically to improve patient quality of living, more so in the beginning stages, where the cycle of pathology has minimal effects. PRP is a lot of platelets concentrated in a less amount of plasma. It is effect to a targeted tendon and cartilage tissue is evident.
Preparation of PRP
To prepare PRP, it is recommended to use of “double-spin” method. Here, the blood is centrifuged at a speed to produce 100–300 G for 10 min in the first spin and then 400–700 G for 10–17 min for another spin (Fig. 1a-c). The sample prepared for treatment of degenerative conditions is recommended to contain at least 1,000,000–1,500,000 platelets/ml [1, 2]. As it is injected into soft-tissues activation of the content is not necessary. Collection of blood, preparation, and injection were done on the same day. Storage was not recommended ^[2].

Inclusion and exclusion criteria

Patient with the early degenerative changes was chosen for the treatment. Elderly who benefits more from total knee replacement or other conservative managements were excluded from the study ^[3]. Infection local and remote was a contra-indication. Other patients with thrombocytopenia or coagulation disorders were not advised to undergo PRP treatment. In general, patients were counseled and explained the nature of the treatment and teamed with proper physiotherapy. Our study group includes patients, 50–80 years, with Kellgren and Lawrence Grade 1 and 2 Osteoarthritis of knee ^[4]. Informed and signed consents taken from all patients.

The Ethical Committee of VMKV Medical College and Hospital, Salem was consulted and approved the study.
Procedure
The patients were prepared and sterile drapped. A 6 ml PRP was injected intra-articular through the anterolateral soft spot or the superior-lateral-patellar approach of the knee ^[5] (Fig. 2a-c). The Fig 2d shows a sterile syringe loaded with the prepared PRP. Cycling done passively and the patients were advised rest for up to 1 day. Compression dressing and ice pack with oral NSAID and Collagen-1, Glucosamine supplements were given. Total of three injections given for 1 month interval. They were reviewed and compared with knee osteoarthritis outcome score (KOOS) over 0, 1, 2, 3, and 6 months (Table 1).

Two patients had persistent swelling for 3 days – Resolved with ice compression.
• No case of infection seen.
• No drop outs.
The results of the study were charted with the pain scale and grading by the KOOS (Table 2). The KOOS is a useful tool in compiling short-and long-term functional quality of knee. It comprises five questions regarding pain, four under symptoms, nine about the day-to-day activity, three questions under recreational and leisure, and two questions for life quality. The score is calculated in percentage from 0 to 100, with 0% being worst of problems and 100% no problems ^[6]. Patients with regular follow-up were found to have a significant improvement of the KOOS score over the period of evaluation. The average score was charted (Chart 1) and “P” value was derived.

Osteoarthritis (OA) is the most common chronic joint illness changing the life activities and functions of living widely ^[7]. It is a cascade of progressive dehydration, cartilage withering, eburnation with formation of loose bodies, and sclerosis of joint surface [4, 7]. The histopathological findings of OA are caused by increase of inflammatory markers such as IL-1, TNF-α, matrix metalloproteinases, nitric oxide, and prostaglandins between the destruction and repair mechanisms of articular cartilage. It shows that homeostasis is disturbed by reduced production of GF, collagen forming protein, proteoglycans, and other anti-inflammatory cytokines (IL-4 and IL-10) and leading to joint destruction ^[8]. PRP treatment in these joints decreases destruction and matrix formation, and synovium improved hyaluronan synthase-2 production and regeneration of cartilaginous cells. The “α” granules of platelet induce release of various GF, including vascular endothelial growth factor. All this aids cell proliferation and protein secretion in a previously deranged knee joint cartilage ^[9]. Injections of plasma proteins from platelet cell concentrate thus control pain and thickness of synovium, mostly by altering targeted of M1 and M2 macrophage-associated factors ^[10]. The pain in arthritis is leukocyte dependent. PRP reduces IL-1β, which produces a chain of 2α in turn reducing leukocyte activity. Some studies with microRNAs suggest delay in PRP treated knee progression of arthritis by controlling inflammation and apoptosis. It is also proven that activated or in-active PRP injections had no differences in vivo observations. GFs released after PRP injection into OA knee joint such as TNF, IGF, transforming growth factor, disintegrin, and fibroblastic growth factor are also shown to have significance [11, 12].

PRP is a wonder therapy in degenerating knee. More number of clinical studies and their results based on outcomes in the early OA knee it has become evident ^[13]. It is a simple, day care procedure, and relatively cost effective in institutional setting. As it provides natural environment for repair of joint, safety is guaranteed. This study showed significant reduction of pain and improved joint activities of patient with measurable increase in active flexion without pain more beneficial in early disease. Hence, we conclude that PRP injection is a promising therapy for the early aseptic degenerative diseases of knee.

PRP is a wonder therapy in degenerating knee. More number of clinical studies and their results based on outcomes in the early OA knee it has become evident ^[11]. It is a simple, day care procedure, and relatively cost effective in institutional setting. As it provides natural environment for repair of joint, safety is guaranteed. This study showed significant reduction of pain and improved joint activities of patient with measurable increase in active flexion without pain more beneficial in early disease. Hence, we conclude that PRP injection is a promising therapy for the early aseptic degenerative diseases of knee.