Björn Mulder: Differentiating PRP Formulations and Cell Counts in Knee and Ankle OA
Björn Mulder, Medical Doctor at DokterMulder.nl, shared a post on LinkedIn:
“PubMed Wrapped – September 2026 – Orthobiologics
PRP vs HA in knee OA – two meta-analyses, two verdicts (J ISAKOS / Arthroscopy)
Alshehri: 28 RCTs, 2,685 pts. PRP beats HA on WOMAC (MD −8.1). Larger effect with leukocyte-poor PRP, multiple injections, KL I–II.
Zhong: 21 RCTs, 1,790 pts. PRP separates from HA only at 12 months. Larger effect with leukocyte-rich, activated PRP.
Platelet dose: neither reports it. Proxies only, and they disagree.
Platelet volume, density and the homeostatic blueprint (J Clin Med)
Everts, Podesta, Sánchez, Harrison et al. Review plus original data, 389 patients.
Platelets are not one population: density spans 1.040–1.091 g/mL, and the dense, high-MPV, alpha-granule-rich ones sediment with the buffy coat and red cells. PRP-MPV correlated with residual RBC (r = 0.50).
Clear-yellow single-spin PRP leaves exactly those platelets in the tube.
Platelet dose: double-spin averaged 2,082 × 10³/µL; MPV rose 7.55 → 8.4 fL. Threshold: ≥1 × 10⁹/mL.
Intraosseous BMC in bilateral ankle OA – 15-year contralateral-controlled (Medicina)
Hernigou, Centeno et al. 88 patients, one ankle treated, one observed. Fusion or arthroplasty: 18% vs 50%. HR 0.24.
Cell dose: HR 0.70 per 10,000 CFU-F. A real dose-response.
PRP vs hydrolyzed type I collagen vs HA in knee OA – RCT (Future Sci OA)
135 pts, KL 2–3, three US-guided injections. HA wins at one month; PRP and collagen hold better to six.
Dose: schedule defined, PRP composition not reported.
PRP and HA vs HA alone in knee OA – 150 knees, 12 months (J Exp Orthop)
Totlis et al. Three injections each arm, KL II–IV. Combination beat HA alone on VAS, KOOS and EQ-5D at 6 and 12 months, and on PASS/MCID responders.
Platelet dose: PRP characterised and reported under DEPA (CCA). HA 20 mg/2 mL, 2.8–3.2 MDa.
Not randomised.
But the only knee study this month that says what was in the syringe.”
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