Osteoarthritis (OA) Knee is a common debilitating condition, for which there is no cure. Although OA is not a life-threatening condition, the severity of this disease lies in the continuous pain and functional impairment.  

It is evident from the literature, that cartilage loss is not only a pathologic process that triggers OA. Subchondral bone is identified as the starting place for pathologic changes, and cartilage is the victim of this process. In OA, the sub-chondral bone undergoes changes which include microcrack, structural defects and progressive replacement of the subchondral marrow with fibro neurovascular mesenchymal tissue.  Hence, lesions in this subchondral tissue lead inevitably to the onset of OA, if they are not treated properly.

The popular biologic therapy, autologous platelet rich plasma (PRP), prepared from patients own blood, contains a pool of growth factors for cartilage repair.  Biological analysis of PRP has also demonstrated an anti-inflammatory effect on the intra-articular environment. The use of platelet-rich plasma (PRP) for the treatment of osteoarthritis (OA) has demonstrated mixed clinical outcomes in randomized controlled trials. 

 As it is yet to establish which of the joint tissues, among synovial membranes, synovial fluid, articular cartilage or sub-chondral bones, is the primary driver of OA Knee, it is not clear whether we should target one or multiple tissues or structures during interventions. We can assume that targeting several joint tissues or structures at a time, can provide a better result. 

 Hence, we are planning to conduct this study to see whether the addition of intra-osseous injections of PRP directly into the subchondral bone to conventional intra-articular treatment would achieve a better positive effect in OA Knee.