Search Results (189)

Background/Objectives: Gait abnormalities in advanced knee osteoarthritis (KOA) are characterized by decreased stride length, walking speed, and cadence. Total knee arthroplasty (TKA) is intended to improve temporal–spatial gait parameters; however, the extent and timing of functional recovery remain under investigation. To assess changes in stride length, walking speed, and cadence following TKA in short- and long-term perspectives, and to compare outcomes with a non-operated KOA cohort. Methods: A prospective observational study was conducted involving 46 patients with unilateral KOA (grades III–IV, Kellgren–Lawrence scale) who underwent cemented TKA via a medial parapatellar approach. Group I (n = 34) was assessed one day prior to surgery and six weeks postoperatively. Group II (n = 12), a follow-up subset, was reassessed 1.5 years postoperatively. Group III (n = 34) served as a non-operated control group, assessed only preoperatively. Temporal–spatial gait parameters were evaluated under standardized conditions using a two-dimensional video analysis (Kinovea^® software version 0.8.27). Stride length (m) and walking speed (m/s) were assessed during continuous walking along a 15 m corridor, with at least three valid gait cycles averaged per trial. Cadence (steps/min) was determined during a one-minute walk and verified frame-by-frame. No structured outpatient physiotherapy was provided; all patients followed a standardized in-hospital rehabilitation protocol. Results: In Group I, the mean stride length increased from 0.40 ± 0.10 m to 0.42 ± 0.10 m (p = 0.247), walking speed improved from 0.41 ± 0.027 m/s to 0.47 ± 0.022 m/s (p = 0.063), and cadence increased significantly from 72.9 ± 7.8 to 77.1 ± 8.6 steps/min (p = 0.044). In Group II, the mean stride length rose from 0.39 ± 0.10 m to 0.52 ± 0.09 m (p < 0.001), walking speed improved from 0.44 ± 0.02 m/s to 0.69 ± 0.01 m/s (p < 0.001), and cadence increased from 73.7 ± 8.8 to 103.6 ± 7.4 steps/min (p < 0.001). Compared to the control group (Group III: stride length 0.42 ± 0.09 m; walking speed 0.41 ± 0.02 m/s; cadence 73.9 ± 7.9 steps/min), Group II demonstrated superior values across all parameters (p < 0.001 for each comparison). No significant correlations were observed between BMI and gait outcomes. Conclusions: Total knee arthroplasty resulted in progressive improvement in temporal–spatial gait parameters. While early postoperative gains were limited, substantial functional restoration was observed at long-term follow-up, emphasizing the importance of extended recovery monitoring in post-TKA evaluation. Full article

Background: The intercondylar notch (IN) houses the central ligaments of the knee joint, namely the anterior and posterior cruciate ligaments (ACL and PCL) as well as the anterior and posterior meniscofemoral ligaments (aMFL and pMFL). As not only the available intercondylar space directly influences the encased ligaments, but also the ligaments themselves may influence each other, the purpose of this study was to evaluate the influence of osteoarthritis on central ligament morphology. Methods: Imaging data from the osteoarthritis initiative was used to assess 415 randomly selected patients, equally distributed across five groups based on osteoarthritis severity using the Kellgren and Lawrence classification. MRI scans were used to measure ligament structures in the coronal, axial and sagittal planes. The ACL was evaluated and classified into healthy, pathologic and ruptured. The relationship between osteoarthritis severity and the shape of the IN (A-shape, inverse-U-shape and Ω-shape) was analyzed in relation to ligament morphometrics and ACL condition. Results: The morphology of the ligaments is directly influenced by the development of osteoarthritis. In particular, the Ω-shape, which is associated with severe-grade osteoarthritis, is a risk factor for the development of ACL rupture (p < 0.001). But also, the condition of the ACL influenced the morphometrics of the posterior ligaments, and the PCL as well as the MFLs influenced each other. Conclusions: Statistically significant morphological changes to the encased ligaments in the intercondylar space in osteoarthritis were reported. In particular, the ACL shows a higher risk for pathological changes during ongoing joint degeneration due to osteoarthritis. The other evaluated ligaments—MFLs and PCL—are influenced by the condition of the osseous structures and the shape of the IN as well as by the condition and continuity of the ACL. Full article

Background/Objectives: This Phase 3, randomised, double-blind, multicentre trial evaluated the efficacy and safety of a novel hyaluronic acid hydrogel cross-linked with hexamethylenediamine (HMDA-HA) compared to a conventional 1,4-butanediol diglycidyl ether cross-linked HA (BDDE-HA) in patients with mild-to-moderate knee osteoarthritis (OA). Methods: A total of 223 adults (mean age 63.5 years; 167 women) with Kellgren–Lawrence (KL) grade I–III knee OA were randomised 1:1 to receive two intra-articular injections of HMDA-HA or BDDE-HA at baseline and at 24 weeks. The primary endpoint was changes from baseline in weight-bearing pain (WBP) on a 100 mm visual analogue scale (VAS) at Week 12, assessed in the per-protocol population. A non-inferiority margin of 10 mm was predefined. Secondary outcomes included global assessments, Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index scores, responder rates, and rescue medication use [ClinicalTrials.gov: NCT06307847]. Results: At Week 12, least squares mean change (standard error [SE]) in WBP was −23.72 (1.88) mm in the HMDA-HA group (n = 83) and −25.99 (1.76) mm in the BDDE-HA group (n = 95), yielding a difference of 2.26 mm (95% confidence interval [CI]: −2.83 to 7.34; p = 0.3825), thus demonstrating the non-inferiority of HMDA-HA to BDDE-HA. Secondary outcomes were comparable between groups. A total of 136 adverse events were reported: 44 (41.1%) in the HMDA-HA group and 32 (28.1%) in the BDDE-HA group, with no treatment-related adverse drug reactions. Conclusions: A single-injection intra-articular regimen of HMDA-HA was effective and safe for the treatment of adult patients with mild-to-moderate knee OA. Full article

Osteoarthritis (OA) is the most prevalent degenerative joint disorder worldwide, causing significant declines in quality of life. The osteochondral junction (OCJ), a critical structural interface between deep cartilage and subchondral bone, plays an essential role in OA progression but is challenging to assess using conventional magnetic resonance imaging (MRI) due to its short T2 relaxation times. This study aimed to evaluate the utility of ultrashort echo time (UTE) MRI biomarkers, including macromolecular fraction (MMF), magnetization transfer ratio (MTR), and T2*, for in vivo quantification of OCJ changes in knee OA for the first time. Forty-five patients (mean age: 53.8 ± 17.0 years, 50% female) were imaged using 3D UTE-MRI sequences on a 3T clinical MRI scanner. Patients were stratified into two OA groups based on radiographic Kellgren–Lawrence (KL) scores: normal/subtle (KL = 0–1) (n = 21) and mild to moderate (KL = 2–3) (n = 24). Quantitative analysis revealed significantly lower MMF (15.8  ±  1.4% vs. 13.6 ± 1.2%, p < 0.001) and MTR (42.5 ± 2.5% vs. 38.2  ±  2.3%, p < 0.001) in the higher KL 2–3 group, alongside a higher trend in T2* values (19.7  ±  2.6 ms vs. 21.6  ±  3.8 ms, p = 0.06). Moreover, MMF and MTR were significantly negatively correlated with KL grades (r = −0.66 and −0.59; p < 0.001, respectively), while T2* showed a weaker positive correlation (r = 0.26, p = 0.08). Receiver operating characteristic (ROC) analysis demonstrated superior diagnostic accuracy for MMF (AUC = 0.88) and MTR (AUC = 0.86) compared to T2* (AUC = 0.64). These findings highlight UTE-MT techniques (i.e., MMF and MTR) as promising imaging tools for detecting OCJ degeneration in knee OA, with potential implications for earlier and more accurate diagnosis and disease monitoring. Full article

Background: High in-domain accuracy in healthcare machine learning (ML) models does not guarantee reliable clinical performance, especially when training and validation protocols are insufficiently robust. This paper presents a standardized framework for training and validating ML models intended for classifying medical conditions, emphasizing the need for clinically relevant evaluation metrics and external validation. Methods: We apply this framework to a case study in knee osteoarthritis grading, demonstrating how overfitting, data leakage, and inadequate validation can lead to deceptively high accuracy that fails to translate into clinical reliability. In addition to conventional metrics, we introduce composite clinical measures that better capture real-world utility. Results: Our findings show that models with strong in-domain performance may underperform on external datasets, and that composite metrics provide a more nuanced assessment of clinical applicability. Conclusions: Standardized training and validation protocols, together with clinically oriented evaluation, are essential for developing ML models that are both statistically robust and clinically reliable across a range of medical classification tasks. Full article

Background: Platelet-rich plasma (PRP) is increasingly utilized for managing knee osteoarthritis (KOA), yet its clinical value remains debated due to the variability in preparation protocols and outcome measures. Methods: This narrative review synthesizes current evidence from 40 high-quality studies published between 2013 and March 2025, including randomized controlled trials, systematic reviews, and meta-analyses. The biological mechanisms, clinical effectiveness, safety, and implementation challenges of PRP therapy in KOA are examined. Results: PRP injections—particularly leukocyte-poor PRP—demonstrate superior pain relief and functional improvement compared to hyaluronic acid and corticosteroids, especially in patients with mild to moderate KOA (Kellgren–Lawrence grades I–III). However, heterogeneity in PRP formulations (platelet/leukocyte content and activation protocols), injection regimens, and follow-up durations limits direct comparability across studies. Evidence from high-quality placebo-controlled trials shows inconsistent long-term benefits, with some failing to demonstrate superiority over saline beyond 6–12 months. The GRADE assessment rates the overall certainty of evidence as moderate. PRP appears safe, with few adverse events reported, but remains costly and variably reimbursed. Guidelines from major societies remain cautious or inconclusive. Conclusions: PRP is a promising, safe, and well-tolerated option for early to moderate KOA. However, the standardization of preparation protocols, patient selection criteria, and outcome reporting is essential to improve comparability and guide clinical practice. Full article

Background/Objectives: Ochronosis is an uncommon metabolic condition caused by a deficiency of homogentisate 1,2-dioxygenase, leading to the accumulation of homogentisic acid (HGA) in connective tissues. This deposition of HGA in the joints can result in cartilage degeneration and advanced ochronotic arthritis. Although this condition is usually asymptomatic, it can demonstrate devastating articular destruction characterized by dark pigmentation of the tissues. Methods: A 64-year-old female with a medical history consisting of diabetes mellitus type 2, hypertension, and thoracic aortic aneurysm, with no personal or family history of ochronosis or related symptoms, has been diagnosed with progressive knee osteoarthritis, Kellgren and Lawrence grade III, unresponsive to conservative treatment. Results: The patient underwent staged bilateral, bicompartmental, cemented total knee arthroplasty (TKA), during which several pathological changes were incidentally discovered: black-pigmented, weakened articular cartilage and darkened synovial fluid, as well as brittle metaphyseal bone necessitating increased cement application to ensure prosthetic stability. Postoperative recovery was significant for anemia requiring a blood transfusion. Improved knee function was observed in the first month follow-up visit, and the patient was referred for diagnostic confirmation of her condition. Conclusions: This case underscores the importance of recognizing ochronosis as a potential cause of advanced joint degeneration in patients undergoing arthroplasty. Furthermore, the diagnosis might be of clinical relevance, since this case demonstrated postoperative anemia which required blood transfusion. This, combined with the brittleness of bone, highlights the need for meticulous surgical planning and tailored approaches by the unaware surgeon who might encounter such not-so-pleasant findings. Full article

Background and Objectives: Infrapatellar fat pad impingement syndrome (IFPIS) is a relatively underdiagnosed cause of anterior knee pain. While conservative management is the initial approach, some patients require surgical intervention. This study aimed to evaluate the long-term clinical and radiologic outcomes following arthroscopic resection of the infrapatellar fat pad in patients with IFPIS. Materials and Methods: Eighteen patients (10 females, 8 males; median age 22) diagnosed with IFPIS and unresponsive to conservative therapy underwent arthroscopic partial or subtotal resection between 2007 and 2013. Diagnosis was based on physical examination (Hoffa’s test), MRI findings, and response to lidocaine injection. Clinical outcomes (VAS, IKDC-2000, Kujala, Lysholm, Tegner activity scores) and radiologic assessments (ISR, CDI, PFJ osteoarthritis grade) were evaluated preoperatively, at 2 years, and at a final follow-up (mean 148.7 months). Results: All clinical scores significantly improved postoperatively. VAS decreased from 7.25 ± 0.79 to 2.43 ± 1.50 at 2 years, and to 3.66 ± 1.50 at the final follow-up (p < 0.001). Similar long-term improvements were observed in the Kujala, IKDC-2000, Lysholm, and Tegner scores (all p < 0.001). Radiographic parameters including ISR and CDI remained stable, and there was no statistically significant progression in patellofemoral osteoarthritis. However, 5 of 18 patients (27.8%) reported persistent symptoms at long-term follow-up. Conclusions: Arthroscopic resection of the infrapatellar fat pad in patients with IFPIS showed favorable and sustained clinical outcomes over a 10-year follow-up, without significant radiological changes. These results suggest that arthroscopic resection is a viable treatment option when accurate diagnosis is established. Full article

Background: Knee Osteoarthritis (KOA) is a prevalent and debilitating joint disorder that significantly impacts quality of life, particularly in aging populations. Accurate and consistent classification of KOA severity, typically using the Kellgren-Lawrence (KL) grading system, is crucial for effective diagnosis, treatment planning, and monitoring disease progression. However, traditional KL grading is known for its inherent subjectivity and inter-rater variability, which underscores the pressing need for objective, automated, and reliable classification methods. Methods: This study investigates the performance of an EfficientNetB5 deep learning model, enhanced with transfer learning from the ImageNet dataset, for the task of classifying KOA severity into five distinct KL grades (0–4). We utilized a publicly available Kaggle dataset comprising 9786 knee X-ray images. A key aspect of our methodology was a comprehensive data-centric preprocessing pipeline, which involved an initial phase of outlier removal to reduce noise, followed by systematic label correction using the Cleanlab framework to identify and rectify potential inconsistencies within the original dataset labels. Results: The final EfficientNetB5 model, trained on the preprocessed and Cleanlab-remediated data, achieved an overall accuracy of 82.07% on the test set. This performance represents a significant improvement over previously reported benchmarks for five-class KOA classification on this dataset, such as ResNet-101 which achieved 69% accuracy. The substantial enhancement in model performance is primarily attributed to Cleanlab’s robust ability to detect and correct mislabeled instances, thereby improving the overall quality and reliability of the training data and enabling the model to better learn and capture complex radiographic patterns associated with KOA. Class-wise performance analysis indicated strong differentiation between healthy (KL Grade 0) and severe (KL Grade 4) cases. However, the “Doubtful” (KL Grade 1) class presented ongoing challenges, exhibiting lower recall and precision compared to other grades. When evaluated against other architectures like MobileNetV3 and Xception for multi-class tasks, our EfficientNetB5 demonstrated highly competitive results. Conclusions: The integration of an EfficientNetB5 model with a rigorous data-centric preprocessing approach, particularly Cleanlab-based label correction and outlier removal, provides a robust and significantly more accurate method for five-class KOA severity classification. While limitations in handling inherently ambiguous cases (such as KL Grade 1) and the small sample size for severe KOA warrant further investigation, this study demonstrates a promising pathway to enhance diagnostic precision. The developed pipeline shows considerable potential for future clinical applications, aiding in more objective and reliable KOA assessment. Full article

Background: Some evidence suggests that combining hyaluronic acid (HA) with platelet-rich-plasma (PRP) may offer synergistic benefits by enhancing the biological and mechanical properties of joints. However, data on the combination of HA+PRP vs. HA alone in the management of knee osteoarthritis (OA) remain limited. Methods: A double-blinded randomized controlled trial was conducted at an outpatient clinic and enrolled 58 patients with Kellgren–Lawrence grade 2–3 knee OA. They were randomly allocated to receive either intra-articular PRP combined with HA (n = 29 knees) or HA alone (n = 29 knees). The primary outcome was pain, assessed using a visual analog scale (VAS). Secondary outcomes included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), health-related quality of life (EQ-5D-5L), and structural changes on MRI, measured by the Whole-Organ MRI Score (WORMS). The VAS, WOMAC, and EQ-5D-5L were evaluated at baseline and at months 1, 3, 6, and 12. MRI WORMS was assessed at baseline and 12 months. Results: The baseline characteristics were comparable between the HA+PRP and HA groups. Both interventions showed improvements in pain and function at 12 months. However, the between-group difference in VAS at 12 months—the primary outcome—was not statistically significant (p = 0.102) and did not exceed the minimal clinically important difference (MCID) of 20 mm. The HA group demonstrated significantly greater VAS score reductions at 1 month (−31.1 [95% CI: −38.9 to −23.2] vs. −14.3 [95% CI: −22.2 to −6.4], p = 0.003) and at 6 months (−32.1 [95% CI: −40.1 to −24.1] vs. −19.2 [95% CI: −27.1 to −11.3], p = 0.024), compared to the HA+PRP group, although these differences did not reach clinical significance. No significant between-group differences were observed in the WOMAC scores, EQ-5D-5L, or total WORMS scores at all time points (p > 0.05). At 12 months, MRI assessment revealed a significant decrease in bone marrow edema in the HA+PRP group (−0.7 [95% CI: −1.6 to 0.2]) compared to the HA group (0.7 [95% CI: −0.2 to 1.6], p = 0.030). Conclusions: Both HA+PRP and HA treatments were effective in reducing pain and improving function in patients with knee OA over 12 months. While HA demonstrated greater early pain relief, the addition of PRP was associated with a significant reduction in bone marrow edema at 12 months. These findings suggest potential structural benefits of HA+PRP, although clinical superiority over HA alone was not established. Full article

Background/Objectives: Knee osteoarthritis (KOA) is a progressive degenerative joint disease characterised by low-grade inflammation and is associated with increased cardiovascular (CV) risk and arterial stiffness. Pulse wave velocity (PWV) is a quantitative measure of arterial stiffness and an important tool for detecting subclinical arterial calcification and CV risk. This study aimed to determine whether PWV can distinguish radiographically mild KOA (Kellgren–Lawrence grades 1-2) from severe KAO (Kellgren–Lawrence grades 3-4) in terms of CV risk factors. Methods: A total of 223 postmenopausal women with KOA participated in this cross-sectional study. Assessments included anthropometry, laboratory analyses, blood pressure and PWV measurements, a 6 min walk test, pain evaluation using a visual analogue scale (VAS), and completion of the International Physical Activity Questionnaire (IPAQ). Results: PWV was significantly higher in the severe KOA group (10.53 m/s vs. 8.78 m/s, p < 0.001). A cut-off value of 8.4 m/s effectively distinguished between severe and mild forms of KOA (AUC = 0.798, p = 0.001). OA grade, pain, age, waist circumference, WHR, SCORE 2/SCORE 2OP, systolic blood pressure, serum glucose, HbA1c, uric acid, creatinine, and erythrocyte sedimentation rate were increased in the group with PWV > 8.4 m/s, compared to the group with PWV ≤ 8.4 m/s. Conversely, eGFR, the 6 min walk test and physical activity of patients were reduced in the group with PWV > 8.4 m/s. A patient with a PWV > 8.4 m/s has a 1.77 times higher chance of developing a more severe form of the disease than a patient with a lower PWV. Conclusions: Patients with a higher PWV are more likely to develop a more severe form of KOA, which is associated with increased cardiovascular risk. Full article

Background: Knee osteoarthritis (KOA) affects 37% of individuals aged ≥ 60 years in the national health survey, causing pain, discomfort, and reduced functional independence. Methods: This study aims to automate the assessment of KOA severity by training deep learning models using the Kellgren–Lawrence grading system (class 0~4). A total of 15,000 images were used, with 3000 images collected for each grade. The learning models utilized were DenseNet201, ResNet101, and EfficientNetV2, and their performance in lesion classification was evaluated and compared. Statistical metrics, including accuracy, precision, recall, and F1-score, were employed to assess the feasibility of applying deep learning models for KOA classification. Results: Among these four metrics, DenseNet201 achieved the highest performance, while the ResNet101 model recorded the lowest. DenseNet201 demonstrated the best performance with an overall accuracy of 73%. The model’s accuracy by K-L grade was 80.7% for K-L Grade 0, 53.7% for K-L Grade 1, 72.7% for K-L Grade 2, 75.3% for K-L Grade 3, and 82.7% for K-L Grade 4. The model achieved a precision of 73.2%, a recall of 73%, and an F1-score of 72.7%. Conclusions: These results highlight the potential of deep learning models for assisting specialists in diagnosing the severity of KOA by automatically assigning K-L grades to patient data. Full article

Knee osteoarthritis (KOA) is a highly prevalent muscoloskeletal joint disorder affecting a significant portion of the population worldwide. Accurate predictions of KOA progression can assist clinicians in drawing preventive strategies for patients. In this paper, we present an integrated approach based on hypergraph convolutional networks (HGCNs) for longitudinal predictions of KOA grades and progressions from MRI images. We propose two novel models, namely, the C_Shape.Net and the predictor network. The C_Shape.Net operates on a hypergraph of volumetric nodes, especially designed to represent the surface and volumetric features of the cartilage. It encompasses deep HGCN convolutions, graph pooling, and readout operations in a hierarchy of layers, providing, at the output, expressive 3D shape descriptors of the cartilage volume. The predictor is a spatio-temporal HGCN network (ST_HGCN), following the sequence-to-sequence learning scheme. Concretely, it transforms sequences of knee representations at the historical stage into sequences of KOA predictions at the prediction stage. The predictor includes spatial HGCN convolutions, attention-based temporal fusion of feature embeddings at multiple layers, and a transformer module that generates longitudinal predictions at follow-up times. We present comprehensive experiments on the Osteoarthritis Initiative (OAI) cohort to evaluate the performance of our methodology for various tasks, including node classification, longitudinal KL grading, and progression. The basic finding of the experiments is that the larger the depth of the historical stage, the higher the accuracy of the obtained predictions in all tasks. For the maximum historic depth of four years, our method yielded an average balanced accuracy (BA) of 85.94% in KOA grading, and accuracies of 91.89% (+1), 88.11% (+2), 84.35% (+3), and 79.41% (+4) for the four consecutive follow-up visits. Under the same setting, we also achieved an average value of Area Under Curve (AUC) of 0.94 for the prediction of progression incidence, and follow-up AUC values of 0.81 (+1), 0.77 (+2), 0.73 (+3), and 0.68 (+4), respectively. Full article

Osteoarthritis (OA) is the most prevalent rheumatologic disease and a leading cause of years lived with disability worldwide. There are no disease-modifying drugs available to treat it. This study aimed to evaluate the effect of a single dose of 100U botulinum neurotoxin-A (BoNT-A) in patients with early knee OA. We designed a single-arm preliminary clinical trial in patients diagnosed with knee OA (KOA) grades I and II. 45 Patients received a single dose of 100U IncobotulinumtoxinA in the retro-patellar bursa and received nutritional and physical rehabilitation indications. Patients were evaluated at baseline and at days 5, 30, 60, and 90 after injection. The primary outcome was the reduction in pain using the visual analog scale (VAS). Knee function was evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). We assessed secondary adverse effects and measured muscular strength in every consultation. Descriptive endpoint summaries and a generalized linear random-effect model were used to evaluate changes in each follow-up time compared to baseline. IncobotulinumtoxinA treatment significantly (p < 0.001) reduced pain in all treated patients at day 90 compared to day 0. Patients showed a significant reduction in total WOMAC score (p < 0.001), from a mean baseline of 44.6 (95% CI; 41.4, 47.8) to 4.4 at day 90 (95% CI; 0.2, 0.3). Our results show that IncobotulinumtoxinA applied in the retro-patellar bursa is a safe and effective treatment for pain in patients with early-stage KOA, offering a potential alternative for symptomatic control in KOA. Full article

Background: Knee osteoarthritis (OA) is a progressive joint disorder characterized by pain, stiffness, and functional impairment. Platelet-rich plasma (PRP) has been widely studied as a biological treatment for OA, with autologous PRP (A-PRP) being the most commonly used formulation. Recently, umbilical cord-derived PRP (C-PRP) has emerged as a potential alternative due to its hypothesized higher regenerative potential. However, evidence supporting its superiority over A-PRP remains limited. This study aims to compare the efficacy and safety of C-PRP and A-PRP in terms of pain relief and functional improvement over a 12-month follow-up period. Methods: This prospective cohort study included 84 patients with mild-to-moderate knee OA (Kellgren–Lawrence grades I–III), into two groups: 44 patients received a single intra-articular injection of C-PRP, and 40 received A-PRP. Pain and functional outcomes were assessed at baseline, 3, 6, 9, and 12 months using the Visual Analog Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Knee Injury and Osteoarthritis Outcome Score (KOOS). Statistical analysis was performed using the Mann–Whitney U, Exact Fisher test, repeated measures general linear model (GLM) and multivariate logistic regression. Results: Both C-PRP and A-PRP led to significant pain reduction and functional improvement over 12 months (p < 0.01 for both groups). Short-term analysis (3–6 months) showed slightly greater pain relief in the C-PRP group (VAS, p = 0.03 at 3 months), but this difference diminished at later time points. By 9 and 12 months, no significant differences were observed between the two groups in any clinical outcome measures (VAS, WOMAC, KOOS; p > 0.05). No serious adverse events were reported, and both treatments were well tolerated. Conclusions: This study found no long-term superiority of C-PRP over A-PRP in terms of pain relief or functional improvement in knee OA. While C-PRP showed a transient advantage in early pain relief, both treatments demonstrated similar clinical outcomes at 12 months. Given the limited scientific evidence supporting C-PRP and its higher logistical costs, A-PRP should remain the preferred PRP therapy for knee OA. Further randomized controlled trials with longer follow-up periods are needed to confirm these findings. Full article