1. 2025;28;207-215Safety and Efficacy of Platelet-Rich Plasma versus Genicular Nerve Radiofrequency Ablation in Knee Osteoarthritis: An Open-Label, Prospective, Randomized, Clinical Trial
   Randomized Clinical Trial
   Shahzad Anwar, MD, Swarnima Vardhan, MD, Abhinav Aggarwal, MD, Sulayman Waquar, PhD, Madhurima Vardhan, PhD, Gull A. Rukh Shoukat, MS, Sudhir A. Diwan, MD, and Annu Navani, MD.

BACKGROUND: Osteoarthritis is the most prevalent joint disorder, marked by significant pain, reduced functionality, and diminished quality of life. The prevalence of chronic knee osteoarthritis is increasing as the population ages. Minimally invasive therapeutic interventions, including platelet-rich plasma and radiofrequency ablation of genicular nerves, have demonstrated substantial efficacy in alleviating pain in these patients.

OBJECTIVE: The objective of this study was to compare the efficacy of intraarticular platelet-rich plasma (PRP) injection and genicular nerve radiofrequency ablation (GNRFA) in alleviating pain associated with knee osteoarthritis.

STUDY DESIGN: An open-label, prospective, randomized clinical trial.

SETTING: A university hospital.

METHODS: This prospective, randomized, open-label clinical trial was conducted on 200 patients with Grade II-III knee osteoarthritis. Of these, 100 patients were assigned to the PRP group, receiving a single intraarticular PRP injection, while the remaining patients in the GNRFA group underwent radiofrequency ablation of the superomedial, superolateral, and inferomedial genicular nerves following a successful diagnostic block. Outcomes were assessed using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI) at the baseline and subsequently at 2 weeks, 3 months, 6 months, one year, and 2 years post-intervention.

RESULTS: VAS scores were significantly lower in the PRP group than in the GNRFA group at 12 and 24 months, with P-values < 0.001. The PRP group also exhibited statistically significant reductions in ODI scores at all pre-specified time points. No adverse effects were reported in either treatment group.

LIMITATIONS: The study did not include a control group, and the assessment of efficacy was primarily based on clinical scores without evaluating structural changes through MRI. Additionally, physical and analgesic therapies were not considered in the data collection.  

CONCLUSION: For patients with chronic knee osteoarthritis, intraarticular platelet-rich plasma therapy may offer superior sustained pain relief and a lower disability index compared to conventional radiofrequency ablation of the genicular nerves.

KEY WORDS: Knee osteoarthritis, biologics, platelet-rich plasma, radiofrequency ablation, chronic pain