• Liam D A Paget, Gustaaf Reurink, Robert-Jan de Vos, Adam Weir, Maarten H Moen, Bierma-ZeinstraSita M ASMADepartment of Orthopedic Surgery and Sports Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands.Department of General Practice, Erasmus University Medical Center, Rotterdam, the Netherlands., StufkensSjoerd A SSASAmsterdam UMC, University of Amsterdam, Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam, the Netherlands.Academic Center for Evidence-based Sports medicine (ACES), Amsterdam, the Netherlands.Amsterdam Collabor, KerkhoffsGino M M JGMMJAmsterdam UMC, University of Amsterdam, Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam, the Netherlands.Academic Center for Evidence-based Sports medicine (ACES), Amsterdam, the Netherlands.Amsterdam Collab, Johannes L Tol, and PRIMA Study Group.
• Amsterdam UMC, University of Amsterdam, Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam, the Netherlands.
• JAMA. 2021 Oct 26; 326 (16): 1595-1605.

ImportanceApproximately 3.4% of adults have ankle (tibiotalar) osteoarthritis and, among younger patients, ankle osteoarthritis is more common than knee and hip osteoarthritis. Few effective nonsurgical interventions exist, but platelet-rich plasma (PRP) injections are widely used, with some evidence of efficacy in knee osteoarthritis.ObjectiveTo determine the effect of PRP injections on symptoms and function in patients with ankle osteoarthritis.Design, Setting, And ParticipantsA multicenter, block-randomized, double-blinded, placebo-controlled clinical trial performed at 6 sites in the Netherlands that included 100 patients with pain greater than 40 on a visual analog scale (range, 0-100) and tibiotalar joint space narrowing. Enrollment began on August 24, 2018, and follow-up was completed on December 3, 2020.InterventionsPatients were randomly assigned (1:1) to receive 2 ultrasonography-guided intra-articular injections of either PRP (n = 48) or placebo (saline; n = 52).Main Outcomes And MeasuresThe primary outcome was the validated American Orthopaedic Foot and Ankle Society score (range, 0-100; higher scores indicate less pain and better function; minimal clinically important difference, 12 points) over 26 weeks.ResultsAmong 100 randomized patients (mean age, 56 years; 45 [45%] women), no patients were lost to follow-up for the primary outcome. Compared with baseline values, the mean American Orthopaedic Foot and Ankle Society score improved by 10 points in the PRP group (from 63 to 73 points [95% CI, 6-14]; P < .001) and 11 points in the placebo group (from 64 to 75 points [95% CI, 7-15]; P < .001). The adjusted between-group difference over 26 weeks was -1 ([95% CI, -6 to 3]; P = .56). One serious adverse event was reported in the placebo group, which was unrelated to the intervention; there were 13 other adverse events in the PRP group and 8 in the placebo group.Conclusions And RelevanceAmong patients with ankle osteoarthritis, intra-articular PRP injections, compared with placebo injections, did not significantly improve ankle symptoms and function over 26 weeks. The results of this study do not support the use of PRP injections for ankle osteoarthritis.Trial RegistrationNetherlands Trial Register: NTR7261.

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