A placebo-controlled study comparing the efficacy of intra-articular injections of hyaluronic acid and a novel hyaluronic acid-platelet-rich plasma conjugate in a canine model of osteoarthritis

• Published in: Journal of orthopaedic surgery and research 2019-09, Vol.14 (1), p.314-314, Article 314
• Main Authors: Lee, Mun-Ik, Kim, Jun-Hyung, Kwak, Ho-Hyun, Woo, Heung-Myong, Han, Jeong-Hee, Yayon, Avner, Jung, Yun-Chan, Cho, Jin-Man, Kang, Byung-Jae
• Format: Article
• Language: English
• Subjects: Acids; Animals; Anterior cruciate ligament; Arthritis; Arthritis, Experimental - complications; Arthritis, Experimental - diagnostic imaging; Arthritis, Experimental - drug therapy; Arthritis, Experimental - pathology; Care and treatment; Cartilage (articular); Cartilage diseases; Cartilage, Articular - pathology; Comparative analysis; Disease; Dog; Dogs; Dosage and administration; Drug delivery systems; Fibrin; Fibrinogen; Fibrinogen - administration & dosage; Fibrinogen - adverse effects; Fibrinogen - therapeutic use; Gait; Gait Analysis - methods; Growth factors; Hyaluronic acid; Hyaluronic Acid - administration & dosage; Hyaluronic Acid - adverse effects; Hyaluronic Acid - therapeutic use; Hyaluronic acid conjugated with autologous fibrinogen from platelet-rich plasma; Hydrogels; Injection; Injections, Intra-Articular; Knee; Lameness, Animal - etiology; Ligaments; Novels; Orthopedics; Osteoarthritis; Osteoarthritis - complications; Osteoarthritis - diagnostic imaging; Osteoarthritis - drug therapy; Osteoarthritis - pathology; Pain; Physiology; Platelet-Rich Plasma; Platelets; Preservation; Radiography; Random Allocation; Sensors; Severity of Illness Index; Statistical analysis; Stifle - diagnostic imaging; Stifle joint; Synovial Membrane - pathology; Synovium; Testing; Veterinary colleges; Veterinary medicine; Viscosupplementation - adverse effects; Viscosupplementation - methods; Viscosupplements - therapeutic use
• ISSN: 1749-799X; 1749-799X
• DOI: 10.1186/s13018-019-1352-1

The objective of this study was to assess the efficacy of intra-articular injections of hyaluronic acid (HA) and a novel, on-site conjugate of HA with autologous fibrinogen in platelet-rich plasma (HA-PRP) in a canine model of osteoarthritis (OA) METHODS: Twelve beagle dogs underwent a unilateral resection of the cranial cruciate ligament (CrCL) of the stifle joint. Clinical and radiographic signs of OA were confirmed in all dogs 8 weeks following CrCL resection and prior to treatment. The dogs were randomized into three groups: saline (n = 4), HA (n = 4), and HA-PRP (n = 4). Each dog received intra-articular injections of the respective substance into the affected joint at pre-determined time points. The dogs were assessed for adverse effects for 3 days after each injection and for lameness, pain, range of motion, kinetics, and radiographic OA severity prior to treatment and 3 months after injection. OA severity as determined by radiographic examination was not significantly different among the groups at any time point. The dogs were then humanely euthanatized and the stifle joint assessed by gross and histological examinations. Dogs treated with four weekly injections of HA or two biweekly injections of HA-PRP were significantly (p < 0.05) better than dogs treated with four weekly injections of saline at 2-, 4-, and 12-week time points based on a comfortable range of motion (CROM) and clinical lameness score. Gait analysis measuring symmetry and weight distribution on pressure sensor walkway showed significantly (p < 0.05) improved limb function for dogs treated with HA and HA-PRP compared with dogs treated with saline yet with better clinical outcome for the HA-PRP-treated group at 12 and 20 weeks follow-up. Gross and histological analysis of synovium and articular cartilage demonstrated significant (p < 0.05) improvement by both treatments groups compared to controls. There was however significantly (p < 0.05) less damage to the cartilage in the HA-PRP group compared to the HA-treated group. These data suggest that while injection of HA and HA-PRP may be sufficient for short-term amelioration of the symptoms associated with OA, treatment with HA-PRP conjugates may be superior, providing significantly better long-term cartilage preservation.