AAPM&R'S Practice Guidance: Orthobiologic Management of Osteoarthritis of the Knee-Session Recording

Video Transcription

Video Summary

The discussion introduces the American Academy of Physical Medicine and Rehabilitation (AAPMNR) practice guideline on orthobiologic management of knee osteoarthritis (OA), focusing on platelet-rich plasma (PRP) therapy. Dr. David Lee, Dr. Pratham Jayaram, and Dr. Jenny Yuan highlight the rigorous, evidence-based methodology used to create concise guidance statements aimed specifically at physiatrists. Unlike broad guidelines from other societies, this guidance focuses on orthobiologics for knee OA, emphasizing clinical applicability.<br /><br />Key points include the heterogeneity of PRP formulations, with emerging evidence supporting both leukocyte-rich and leukocyte-poor PRP for mild to moderate knee OA, while severe OA may require adjunctive treatments such as intraosseous injections targeting the subchondral bone. Dosage recommendations suggest a minimum delivery of 3–5 billion platelets per injection. Minimizing red blood cells in PRP is advised due to potential chondrotoxicity. Image guidance for injection and complete joint aspiration are considered best practices.<br /><br />Patient selection prioritizes mild to moderate OA with persistent symptoms after conservative management. Comorbidities do not preclude PRP but require careful evaluation, especially in active or remission-phase malignancies, where oncology consultation is recommended. The guidance underscores individualized treatment, cautious use of local anesthetics, careful patient education about realistic outcomes (symptom relief rather than regeneration), and consideration of cost and regulatory status.<br /><br />Post-injection protocols encourage early mobilization and integrating physical therapy and bracing, with no evidence supporting prolonged immobilization. The group emphasizes ongoing research needs including precise dosing, formulations tailored to OA phenotypes, and protocols optimizing pre- and post-procedure outcomes.<br /><br />Q&A addressed practical issues such as injection timing relative to steroid use, multiple injection schedules based on clinical response, and management of patellofemoral OA, which often benefits less from PRP. The session closes inviting clinician engagement in future guidance topics. The full guideline is forthcoming in the PM&R Journal.

Keywords

American Academy of Physical Medicine and Rehabilitation

orthobiologic management

knee osteoarthritis

platelet-rich plasma

PRP therapy

leukocyte-rich PRP

leukocyte-poor PRP

intraosseous injections

patient selection

post-injection protocols