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Adding Injectable Chitosan Poloxamer to Platelet Rich Plasma PRP Has no Beneficial Effect in Knee OA. A prospective Experimental Study in Guinea Pigs

LEVEL OF EVIDENCE: 5 SUMMARY Background. Short term symptomatic relief with single dose PRP in early knee OA has been established. We studied the effect of Chitosan as an additive to PRP, in an attempt to improve and prolong the effects. Methods. 42 Dunkin Hartley guinea pigs were divided into 4 groups of 10 each; 2 animals were used for preparation of allogeneic PRP. Disease control group (DC) had 10 animals where no intervention was done in either knee. Groups G1, G2 and G3 (10 animals each) were given single intra-articular injections of PRP, Chitosan gel alone and Chitosan + PRP in one knee respectively. Isotonic saline injection was given in the contralateral knees in all 3 groups to act as control. Five animals from each group (subgroup DC.3, G1.3, G2.3 and G3.3) were euthanized at three months and the remaining five (subgroup DC.6, G1.6, G2.6 and G3.6) at six months post intervention. Upon euthanasia, knee joint synovial fluid was taken for cartilage oligomeric protein (COMP) estimation by ELISA, and histologic assessment of articular cartilage and synovium was done using Mankin score. Results. The mean synovitis scores was significantly lower in both the PRP and Chitosan PRP group compared to disease control and Chitosan gel alone groups at 3 months (p < 0.05) signifying effectiveness of PRP for synovitis; at 6 months there was no difference between the 3 intervention groups and disease control group, implying that the effects of PRP wear off. There was no significant difference between Chitosan PRP and PRP groups at 3 or 6 months in terms of mean total articular cartilage score and COMP levels. The above findings imply that Chitosan addition did not improve or prolong the effects of PRP. Conclusions. Addition of chitosan poloxamer gel did not offer any additional advantage in prolonging efficacy of PRP in a Guinea pig Knee OA model. Nevertheless, the efficacy of single dose PRP, with or without Chitosan, has been again demonstrated in the short term, due to decreased synovitis scores.