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Musculoskeletal and Sports Medicine

(Kiosk 2) Platelet Rich Plasma for Knee Pain in the Setting of Hyperlipidemia in a Marine Veteran

Thursday, November 16, 2023
5:00 PM – 7:00 PM CT

    Primary Author(s)

  • Lauren M.J Cuenant, DO

    Resident Physician
    University of Miami/Jackson Health System PM&R Program
    Miami, Florida

    • Co-Author(s)

  • Angie J. Lastra, MD

    Attending Physician
    Miami VA Healthcare System
    Miami, Florida

  • XA

    Xavier Aviles, MD

    Physician
    VA Hospital Dept of Physical Med and Rehabilitation
    Pembroke Pines, Florida

Case Diagnosis: 39 year old Marine veteran male with chronic right knee pain secondary to chondromalacia and patellar tendinopathy abandoned lipemic Platelet-Rich Plasma (PRP) injection due to unknown consequence.

Case Description or Program Description: 39 year old Marine veteran male presented with chronic, worsening, atraumatic right knee pain attributed to active duty. Pain was refractory to physical therapy, NSAIDs and bracing. Exam was remarkable for medial joint line and patellar tendon tenderness. Maneuvers for laxity and meniscal pathology were negative. Right knee MRI demonstrated medial femoral condyle chondromalacia and patellar tendinopathy. After discussing treatment options, the patient consented to PRP injection trial.

Setting: The patient was seen in outpatient clinic.

Assessment/Results: PRP was initiated after 15cc of autologous venous blood was drawn and mixed with 1.5cc of anticoagulant citrate dextrose and processed in a Drucker Horizon 24 Flex-AH Centrifuge with leukocyte-poor setting. This yielded a pink/milky plasma, distinct from PRP’s typical amber appearance. The procedure was repeated with the same results, and therefore aborted. Labs were notable for elevated low-density lipoprotein (LDL 123) which likely explained the PRP appearance.

Discussion (relevance): Lipemia refers to the presence of a high concentration of lipids in the blood. The effect of elevated serum LDL in the setting of lipemic PRP for the management of knee chondromalacia is unknown. In this case, PRP was aborted. However, studies have shown that L5 LDLs can induce platelet aggregation in atherogenesis. Therefore, they could potentially promote PRP efficacy by stimulating platelet function. Further research is warranted to understand how lipemic PRP may affect patient outcomes.

Conclusions: The treatment of knee chondromalacia by lipemic PRP is unknown. As PRP is often used for the management of musculoskeletal conditions, clinicians should be aware of this variant. Future studies examining the efficacy of lipemic PRP in the setting of elevated LDL may improve safety and help determine appropriate candidacy.