A Letter Released to Chiropractors on
April 27, 2011

Hyaluronic Acid vs. PRP for Knees
Co-Management Options for Chiropractic Physicians

Research demonstrates that a diversified chiropractic management program can offer real benefits to patients with osteoarthritis of the knee.  Spinal manipulation can increase range of motion, restore normal movement of the spine, relax the muscles, improve joint coordination, and reduce pain.  In addition, nutritional, activity, and exercise consultation can provide benefit.  Thusly, patients struggling with osteoarthritis of the knee often seek out chiropractic physicians.  Chiropractors have long been interested in the potential benefits of non-surgical treatments such as prolotherapy, hyaluronic acid (HA), and (more recently) platelet-rich plasma (PRP) injections.  Each of these therapies are available to your patients at my private, referral-based practice.

PRP treatments involve the injection of a patient’s own plasma concentrated with platelets into a problem area.  For more information on how this is done at my practice in Charlotte, visit our website at TaubMD.com.  Platelets contain multiple growth factors important in cartilage regeneration processes as well as anti-inflammatory cytokines which regulate a number of processes related to healing and regeneration.  The consensus expert opinion is that an imbalance between proinflammatory cytokines and anti-inflammatory cytokines causes the progression of osteoarthritis.1  A growing body of evidence shows how PRP effectively treats osteoarthritis of the knee and other cartilage degeneration of the knee.2-13     

Recently, Italian researcher Dr. Elizaveta Kon and colleagues compared PRP intra-articular injection to high molecular weight hyaluronan injections and low molecular weight hyaluronan injections.14  Their results were presented at the 2010 annual meeting of the American Academy of Orthopedic Surgeons. All patients were evaluated at the end of treatment and at six months.  PRP demonstrated more and longer efficacy than HA in reducing pain, reducing symptoms, and improving articular function.      

Even among patients with recalcitrant chondropathies, PRP has been found to reduce pain by more than half for approximately one year.2  The most exciting aspect of this recently discovered treatment for osteoarthritis of the knee is that PRP may actually modulate the disease process (accelerating cartilage regeneration, stimulating the chondral anabolism, and slowing the catabolic process).  Sampson and colleagues used ultrasound to measure actual cartilage thickening in some patients receiving PRP.2    This method of concentrating the body’s own healing properties in problem areas has proven results.  When you have patients struggling with early osteoarthritis or even severe, long-standing chondropathies, please consider the non-surgical therapies available by referral to my private practice.