Platelet Rich Plasma Injections in Conjunction with Arthroscopic Microfracture for Focal Chondral Defects of Knee – Improves Clinical Outcomes or just a Placebo?

Platelet Rich Plasma Injections in Conjunction with Arthroscopic Microfracture for Focal Chondral Defects of Knee – Improves Clinical Outcomes or just a Placebo?

 

Abhishek Gumaste *1, NaveenKumar Patil 2, Rakesh Patil 3, Abhijith Shetty 4, Abhinandan S 5

 

1,2. Associate Professor, department of Orthopaedics, KLE Jagadguru Gangadhar Mahaswamigalu Moorusavirmath Medical college and Hospital, Hubli, KLE Academy of Higher education and Research, Deemed to be University, Belagavi, Karnataka, India- 590010.

3,4. Assistant Professor, department of Orthopaedics, KLE Jagadguru Gangadhar Mahaswamigalu Moorusavirmath Medical college and Hospital, Hubli, KLE Academy of Higher education and Research, Deemed to be University, Belagavi, Karnataka, India- 590010.

5. Senior Resident, department of Orthopaedics, KLE Jagadguru Gangadhar Mahaswamigalu Moorusavirmath Medical college and Hospital, Hubli, KLE Academy of Higher education and Research, Deemed to be University, Belagavi, Karnataka, India- 590010.

 

*Correspondence to: Abhishek Gumaste, Associate Professor, department of Orthopaedics, KLE Jagadguru Gangadhar Mahaswamigalu Moorusavirmath Medical college and Hospital, Hubli, KLE Academy of Higher education and Research, Deemed to be University, Belagavi, Karnataka, India- 590010.

 

Copyright
© 2026 Abhishek Gumaste is an open access article distributed under the Creative Commons Attribution   License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received: 08 July 2026

Published: 01 August 2026
DOI: https://doi.org/10.5281/zenodo.21767433

 

Abstract 

Objective: To determine whether addition of PRP injections during arthroscopic microfracture offers better outcomes than microfracture alone in focal chondral defects of the knee.

Methods: The clinical data of 54 patients with focal chondral defects of the knee treated at our centre between January 2022 to June 2025 were analyzed retrospectively. Patients with focal cartilage defects of knee with defect size <2sq cm who had underwent either Arthroscopic microfracture alone or microfracture combined with intraarticular PRP injection were included. Patients with concomitant injuries like meniscal tears, and ligamentous injuries were excluded. 26patients underwent arthroscopic microfracture alone(control), while 18 patients were given additional intraarticular PRP injections(observation). The Visual analogue scale(VAS) for pain and Lysholm knee scores for functional outcomes between the two groups were compared

Results: VAS score in both the groups decreased at 1 year follow-up, however VAS scores in the observation group were lower than those in the control group ( P<0.001), At 1 year Lysholm scores increased in both groups, however  Lysholm scores in the observation group were higher than those in the control group (P<0.001). Both VAS and Lysholm scores showed significant improvement in observation group

Conclusion: Although Microfracture improves pain and functional outcomes in knee focal cartilage defects, addition of intraarticular PRP shows significant improvement in pain relief and functional outcomes than microfracture alone.

Keywords: microfracture, chondral defects, PRP, knee arthroscopy.

Platelet Rich Plasma Injections in Conjunction with Arthroscopic Microfracture for Focal Chondral Defects of Knee – Improves Clinical Outcomes or just a Placebo?

Introduction

Knee joint, being load bearing is prone to cartilage injuries. Cartilage injuries account for two-thirds of knee surgeries.(1) Being avascular, articular cartilage has limited to no potential for spontaneous repair. (2) Cartilage injuries often lead to focal chondral defects that result in pain and limitation of activity. These chondral defects often necessitate surgical management. (3)

Arthroscopic microfracture has been the traditional mainstay of treating focal chondral defects in view of simplicity of the procedure and predictable functional outcomes. (4,5) However, microfracture results in fibrocartilage like cartilage which has lower elasticity, stiffness and wear resistance, than articular cartilage.(6) As such, an array of adjuvants have been introduced in recent years that can aid in the better repair of damaged chondral tissues. Platelet Rich Plasma (PRP) injections have been of immense interest with several studies claiming improved clinical efficacies using PRP.(7, 8)

The purpose of this study is to determine if PRP injections in conjunction with arthroscopic microfracture lead to better functional outcomes than arthroscopic microfracture alone. We hypothesized that adding PRP injections results in better functional outcomes than arthroscopic microfracture alone in focal chondral defects of the knee.

 

Materials and Methods

Ethical clearance was obtained from the Institutional Ethics committee. Clinical data of patients with focal chondral defects of knee treated at our tertiary care centre, between January 2022 and January 2025 was analysed retrospectively. The patients who satisfied the following inclusion criteria were included

  1. Patients diagnosed with knee chondral injury, Clinically and by MRI.
  2. Patients aged 18-60 years
  3. Patients treated with arthroscopic microfracture technique or PRP combined with arthroscopic microfracture technique
  4. Patients with complete clinical data.

 

We excluded patients with:

  1. Patients combined with injury of the meniscus, ACL /PCL or  obvious joint deformity
  2. Patients with previous fractures in the lower limbs or those with a prior surgery of lower limbs.
  3. Patients with arthritic changes, either tibiofemoral or patellofemoral

Study subjects were divided into two groups, the patients who underwent Arthroscopic Microfracture alone formed the control group and those received additional PRP injection formed the observation group. VAS scores for pain and Lysholm functional scoring for knee, prior surgery, at  3 months, 6 months and 12 months of postoperative follow-up were extracted from the patients database.

The VAS score ranges from 0-10 points. The higher the score, the more severe the pain.(9). The Lysholm score ranged from 0-100 points. The higher the score, the better the knee function.(10)

Surgical procedure:

All patients were operated under spinal anesthesia with a torniquet. In supine position, diagnostic knee arthroscopy through Anterolateral portal was performed. Through the anteromedial portal, the focal cartilage defect was curetted and measured. Intraoperative ICRS grading(11) of cartilage defect was noted. With a microfracture awl, the defect was punctured with multiple holes, each 3mm in depth and 3mm apart. Fat droplets from the microfracture site was confirmed.

Patients in observation group underwent an additional PRP injection . LP-PRP was prepared using an ACP preparation kit. 20 ml venous blood mixed with 1.5ml of anticoagulant solution, which  was centrifuged at 4degrees at 3000rpm to obtain a leucocyte- deficient platelet concentrate. The Platelet rich concentrate was then extracted and injected into the joint. Torniquet released after wound closure and dressing.

Postoperatively, all patients were advised non weight bearing mobilization with walker support for 3 weeks, along with static quadriceps exercises and passive knee ROM. Full weight bearing with support started at 3 weeks and patient were allowed weight bearing without support at 6 weeks of surgery.

At every followup VAS scores and Lysholm scores assessed .

SPSS23.0 was used for data processing. Paired sample t-test was used for comparison before and after the treatment.

 

Results

Retrospective analysis of data showed there were 85 patients with focal cartilage defects of knee during the study period. 54 patients satisfied our inclusion criteria and were included in the study. Out of this, 26 patients were controlled and 18 were observation. (figure1). The intraoperative ICRS cartilage grading has been summarized in table 1.

It was observed that both VAS scores for pain and Lysholm functional scores improved in both the study groups. However, the observation group had lower VAS scores and higher Lysholm scores than the control group, which was statistically significant. (figure 2, figure 3).

 

 

Discussion

Management options for focal chondral injuries of the knee keep evolving. Over four decades, microfracture has remained the mainstay. Arthroscopic microfracture involves debriding damaged cartilage and puncturing the defect with multiple holes that enable the underlying marrow with its constituent stem cells to form a layer over the defect. (11)

However, the regenerated cartilage after microfracture is fibrous and not the native hyaline cartilage. Hence, it has poor elasticity, stiffness and wear resistance than hyaline cartilage. (6).

Hence, the search for a more stable cartilage tissue that is wear resistant and delays the progression to arthritis is inevitable.

Platelet Rich Plasma (PRP), isolated from autologous centrifuged blood with concentrated platelets has been proposed to have growth factors that enable the differentiation of marrow stem cells into chondrocytes. Invitro studies have proven differentiation of stem cells into chondrocytes after PRP addition. (12,13) Activated platelets have been found to release platelet derived growth factor, insulin like growth factor and fibroblast factor that aid in cartilage healing. In addition, it reduces the effect of catabolic factors like interleukins that degrade the cartilage. This provides a better biological environment that enhances cartilage healing. (14)

An animal study using allogenic PRP has found to enchance healing of bone defects. (15) The use of PRP has also found to have aided healing of chronic wounds. (16,17)

However, there are very few studies in literature that have evaluated PRP usage in clinical settings, Duan et al(18) found no benefit of PRP in pain relief in the setting of hemophilic arththrits of knee. The results of their study did not support the use of PRP injections in patients who have hemophilic knee arthritis.

Lee et al(19), however, in their study comparing arthroscopic microfracture against microfracture combined with PRP injections in patients aged 40 and above with knee cartilage defect concluded that there was significant clinical improvement in PRP group than microfracture alone. A second look arthroscopy showed cartilage with better elasticity and hardness than the microfracture group.

Our study shows similar results. Though there was improvement in pain perception and functional outcomes in both the groups, the observation group had lower VAS scores and higher Lysholm scores than the control group, which was statistically significant.

Wang etal(20), studied the short-term outcomes of PRP injection in osteoarthritic knees and found out favorable pain and functional outcomes with PRP injection in knee osteoarthritis. We, however, recommend PRP injections only in focal cartilage defects of knee and not in an arthritic knee.

There is very low-rate adverse events with PRP injection and the best curative effect is at about 1 year. (21) We had no adverse events reported and with a follow-up of 12 months, there was significant improvement in the functional outcomes.

leucocyte rich PRP has been found to hinder healing due to the presence of catabolic signals that initiate inflammatory cytokine expression. Hence, leucocyte deficient PRP has been recommended for therapeutic purposes. (22) Our centrifugation process (as recommended by the manufacturer) yielded a leucocyte deficient PRP concentrate.

Nevertheless, we would recommend a second look arthroscopy as well as MR imaging at 1 year to ascertain the mechanical properties of the regenerated cartilage. However, in our study, due to socioeconomic factors of the patients, the same couldn’t be undertaken. Further randomized control studies would be needed to arrive at better conclusions.

 

Conclusion

Although arthoscopic microfracture remains the mainstay of management of focal chondral defects of knee, additional PRP injections significantly improve pain and functional outcomes with minimal adverse events.

 

Acknowledgments – None

*Funding – None

*Conflicts of Interest – None

*Data availability statement – retrospectively data extracted from hospital records.

 

*Author contribution statement –

Author 1- study design, manuscript preparation , corresponding author

Author2 – data collection,

Author 3- statistical analysis

Author 4- statistical analysis

Author 5- data collection and manuscript preparation

*Ethics approval – study was approved by the institutional ethical committee

Declaration of Competing Interest- the authors declare no competing interest

Funding Statement – no external source of funding was obtained for the study

Guardian/Patient's consent – informed , written consent was obtained from the patient for study participation.

Ethical Statement – study was approved by the Institutional Ethics committee

Acknowledgement - None

 

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