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Regenerative Research Roundup - April 2024

Welcome to the Regenerative Research Roundup, where we look through recently published research and bring you the best of the best in a quick-to-read digest.

This month, we cover:

  1. PRP v. MFAT for Knee OA

  2. PRP v. Shockwave Therapy for Plantar Fasciitis

  3. Fragility analysis for PRP in Knee OA

Let's dive in!


Platelet-Rich Plasma Versus Alternative Injections for Osteoarthritis of the Knee: A Systematic Review and Statistical Fragility Index–Based Meta-analysis of Randomized Controlled Trials

The American Journal of Sports Medicine // LOE: I

This study aimed to evaluate the robustness of randomized controlled trials (RCTs) that compare the use of platelet-rich plasma (PRP) with other nonoperative treatments for knee osteoarthritis (OA). The analysis included outcomes from 1993 patients.


The fragility index (FI) and reverse fragility index (RFI) employed are useful tools in this analysis as they measure the robustness of a study's conclusions. The FI indicates the minimum number of patients whose outcomes would need to change to alter the study's statistical significance, while the RFI measures how many additional events would need to occur to achieve statistical significance if the study's results were not initially significant. These indices provide a simple, intuitive way to understand the stability of a study's results.


In the meta-analysis, PRP showed a significantly higher success rate compared to hyaluronic acid. It also showed better patient-reported symptom relief, lower need for further treatment after the initial injection, and more frequent significant pain improvement compared to other nonoperative treatments. 


Authors found that five (5) events were needed to reverse significance of individual RCTs. They suggest that PRP treatment for knee OA is more robust than about half of all similar medical and healthcare studies.


Microfragmented Adipose Tissue Is Equivalent to Platelet-Rich Plasma for Knee Osteoarthritis at 12 Months Posttreatment: A Randomized Controlled Trial

Orthopaedic Journal of Sports Medicine // LOE: I

This randomized controlled trial compared the effectiveness of platelet-rich plasma (PRP) and microfragmented adipose tissue (MFAT) treatments for knee osteoarthritis (OA). The study involved 71 patients with symptomatic knee OA who were divided into two groups; one received PRP treatment and the other MFAT treatment, both administered via a single injection under ultrasound guidance.


An important detail to note is that the cellular composition of the PRP was 16 times above baseline. This is significant as recent studies have shown that a potential “dose-response” curve exists at increasing concentrations of PRP, suggesting that higher concentrations could lead to better outcomes.


The patients' outcomes were measured using the Knee injury and Osteoarthritis Outcome Score (KOOS), a visual analog scale for pain, and the Tegner activity level. These measurements were taken at baseline and at 1, 3, 6, and 12 months after the injection.



Of the 71 patients, 49 completed their 12-month follow-up. Both treatment groups showed improved KOOS-Pain scores, with no significant difference between the two (PRP, 78 ± 17.9 vs MFAT, 77.8 ± 19.3; P = .69). Similar improvements were observed in the other KOOS subscales, visual analog scale for pain, and Tegner scores, with no differences between the two treatment groups.


In conclusion, both PRP and MFAT treatments for knee OA resulted in improved patient-reported outcomes at 12 months post-treatment, with no significant difference between the two treatments. The study further validates that at sufficient concentrations, PRP can offer significant benefit to patients even when comparing it to a more “advanced” biologic like MSC-rich adipose tissue.


Platelet-Rich Plasma vs Extracorporeal Shock Wave Therapy in the Treatment of Plantar Fasciitis at 3-6 Months: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Foot & Ankle International // LOE: I

Both PRP and Shockwave therapy are common treatment modalities for combating Plantar Fasciitis. This meta-analysis examines the effectiveness of PRP injections versus extracorporeal shock wave therapy (ESWT), utilizing only randomized controlled trials that reported: mean and standard deviations for visual analog scale (VAS) pain scores and plantar fascia thickness (PFT).


Six trials, with a total of 432 subjects, were analyzed. The PRP group showed a statistically significant improvement in both VAS pain and PFT compared to the ESWT group. However, the difference in pain reduction between PRP and ESWT was not clinically significant. 


It is worth noting that while this review does not indicate one treatment modality is superior to the other, there are prior research articles that suggest co-administration of the two therapies can be a successful approach. This is both evident in the research as well as reported anecdotally by clinicians working with MD Biologix.


If you have any questions or comments regarding the above research, or are wondering how you can apply it to your regenerative practice, please leave a comment below or shoot me an email at




This blog post provides general information to help the reader better understand regenerative medicine, musculoskeletal health, and any related subjects. The views and opinions expressed in this post are those of the author and may not reflect the views and opinions of MDBiologix. All content provided in this blog, website, or any linked materials, including text, graphics, images, patient profiles, outcomes, and information, are not intended and should not be considered or used as a substitute for medical advice, diagnosis, or treatment. Please always consult with a professional and certified healthcare provider to discuss if any treatment is right for you.


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