To compare the clinical outcomes in the treatment of osteoarthritis (OA) of the knee with platelet lysate (PL) versus platelet-rich plasma (PRP) or hyaluronic acid(HA).

This prospective randomized controlled clinical trial involved 150 patientsadmitted in Wendeng orthopaedic hospital of Shandong province from April 2012to September 2015. The patients were randomly divided into three groups: PL group, PRP group and HA group (50 cases in each). The frequency of PL, PRP and HA injection was three times a week and for five weeks. The Western Ontario McMaster University (WOMAC) pain score, Lequesne swelling score and WOMAC osteoarthritis index were used to evaluate the joint pain, swelling and comprehensive function of patients among three groups before and one, three, and six months after treatment. The incidence of adverse events was record and compared among the three groups. Fisher exact test, variance analysis or t test were performed for data comparison.

At the six month follow-up, 49 cases of PL group, 48 cases of PRP group and 47 cases of HA group successfully completed treatment. Three groups had the lowest WOMAC pain score at one months after treatment. Compared with the HA group, the WOMAC pain scores of the PL group and the PRP group were lower than those in the HA group (three months: t=1.115, P<0.01, t=2.343, P<0.05; six months: t=0.463, P<0.05, t=1.983, P<0.01)at three and six months after treatment. There was no significant difference of WOMAC pain scores between PL group and PRP group (t=3.123, 2.983, both P>0.05). Lequesne swelling score in PL group was lower than those in PRP group and HA group at three months after treatment, and the difference was statistically significant(t=3.132, P<0.05, t=1.545, P<0.01). Compared with the HA group, the Lequesne swelling scores of PL group and the PRP group were lower (t=2.513, P<0.05, t=3.313, P<0.01)at six months after treatment. However, there was no significant difference between PL group and PRP group (t=2.343, P>0.05). The WOMAC score of the PL groups was lower than those of the PRP group and the HA group at three months after treatment, and the difference was statistically significant (t=2.442, P<0.05, t=2.415, P<0.01). In the meantime, the WOMAC score of the PRP groups was lower than that of the HA group(t=1.324, P<0.01). Compared with the HA group, the WOMAC scores of PL group and the PRP group were lower than those in the HA group (t=1.613, 2.913, both P<0.01)at sixmonths after treatment. However, there was no significant difference between PL group and PRP group (t=3.413, P>0.05). In the comparison of the total incidence of adverse reactions, the incidence of adverse reactions in PL group(2.0%) was lower than that of HA group (8.5%), and the difference was statistically significant (P<0.05). The incidence of adverse reactions in PL group was lower than that of PRP group (P >0.05), and the incidence of adverse reactions in PRP group was lower than that of the HA group (P>0.05), but the difference was not statistically significant.

Compared with PRP, PL in the treatment of knee osteoarthritis could achieve the same effect, and both of them are superior to HA, meanwhile, the incidence of adverse reactions of PL is lower.