Summary

LP-PRP may be a more effective adjuvant treatment for OLT surgery than LR-PRP

Abstract

Introduction

It is unclear whether leukocyte-poor platelet-rich plasma (LP-PRP) or leukocyte-rich PRP (LR-PRP) treatment is more suitable as an adjuvant therapy following surgery for osteochondral lesions of the talus (OLT). The aim of this study is to compare the clinical outcomes and time to return to activity between LP-PRP and LR-PRP in OLT surgery.

Methods

We retrospectively reviewed data from 29 patients who underwent OLT surgery, who were treated with microfracture techniques and retrograde drilling in addition to PRP therapy. Eleven patients received LP-PRP and 18 received LR-PRP at the surgery. We assessed the timeline for resuming activities and evaluated the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) scores preoperatively and at 3 months, 6 months, and 2 years postoperatively.

Results

The time to commence jogging and fully return to sports was significantly shorter in the LP-PRP group than in the LR-PRP group. All patients returned to full sports activities within 5 months post-surgery without deviation. Compared with the preoperative scores, the SAFE-Q scores at 6 months post-surgery were significantly greater in both the LP-PRP and LR-PRP groups across all items, except for sports activity. Furthermore, the 6-month SAFE-Q scores were generally better than those at 3 months post-surgery in both groups. Although no significant differences were found in the SAFE-Q scores between the groups at 3 months, 6 months, and 2 years post-surgery, the cores of the LR-PRP group tended to decrease across all items except for sports activity at 2 years. Notably, physical function, daily living, and social scores decreased to preoperative levels in the LR-PRP group. Conversely, the LP-PRP group maintained favorable SAFE-Q scores even 2 years post-surgery, with all items significantly higher than the preoperative scores.

Discussion

Previous reports have suggested that LR-PRP shows promise in treating cartilage injuries and osteoarthritis; however, LP-PRP has been shown to be more effective in pain relief and functional improvement compared to LR-PRP. In our study, we did not find significant functional differences between the two groups, but the LP-PRP group was able to return to sports more quickly than the LR-PRP group. Nevertheless, several reports indicate that the effects of PRP treatment diminish after more than two years. Additionally, while LR-PRP significantly expressed more interleukin(IL) -1Ra, IL-4, and IL-8, suggesting that it has greater anti-inflammatory potential than LP-PRP, it also exhibits elevated matrix metalloproteinase (MMP) -9 levels, indicating high cartilage toxicity. These findings suggest that although LR-PRP strongly suppresses inflammation, its long-term efficacy for cartilage injuries such as OLT does not persist and may potentially lead to adverse effects on the cartilage. These insights align with our study, where the scores for the LR-PRP group declined two years post-surgery.

Significance

PRP is a promising treatment for enhancing the outcomes of surgeries for OLT. In particular, compared with LR-PRP, LP-PRP enabled an earlier return to sports. Additionally, LP-PRP maintained good clinical scores 2 years after surgery, whereas LR-PRP tended to decrease clinical scores, suggesting that LP-PRP may be an effective adjuvant treatment for OLT surgery.