{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T16:44:30Z","timestamp":1792082670048,"version":"4.4.0"},"reference-count":27,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J. exp. orthop."],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Single\u2010injection freeze\u2010dried platelet factor concentrate (PFC\u2010FD) has been shown to be safe and effective in the treatment of early knee osteoarthritis (OA) with clear advantages over other PRP processing methods. No previous clinical investigations have examined multiple PFC\u2010FD doses. The aim of this study was to assess the safety and effectiveness of one versus three PFC\u2010FD injections in patients with knee OA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Patients with Kellgren\u2013Lawrence (KL) Grade I\u2013IV knee OA were prospectively recruited via shared decision\u2010making based on patient preference to receive either one (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091054) or three (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009317) PFC\u2010FD injections. Patients completed a pre\u2010injection knee injury and OA outcomes survey (KOOS). Post\u2010injection, patients completed the KOOS at 1, 3, 6 and 12 months. Adverse events were documented. Response to treatment was assessed using the Outcome Measures in Rheumatology (OMERACT)\u2010Osteoarthritis Research Society International responder criteria. Multivariable modelling assessed treatment effectiveness, adjusting for patient differences.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The three\u2010injection cohort demonstrated a small advantage in all KOOS subscales except quality of life (QOL) at 1 month (2.4\u20134.0 points,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001\u20130.004), but this advantage disappeared by 3 months. When only early OA (KLI\u2013II) was considered, the three\u2010injection cohort demonstrated higher improvement at 1, 3 and\/or 6 months for most KOOS subscales. No such differences were observed for advanced OA patients. Multivariable analysis demonstrates that three\u2010injection patients were more likely to achieve responder status for KOOS\u2010Pain and KOOS\u2010activities of daily living (ADL) at 12 months (70.9% vs. 60.9%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02 and 55.7% vs. 47.3%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.009, respectively). Overall patient\u2010level adverse events were higher in the three\u2010injection group (21.3% vs. 6.9%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), though adverse events per injection did not differ between groups (one\u2010injection 6.9%, three\u2010injection 8.6%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.19).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Based on non\u2010randomized allocation, a three\u2010injection PFC\u2010FD treatment protocol demonstrates a higher likelihood of clinical response compared to a one\u2010injection protocol, particularly for relief of early knee OA symptoms, without evidence of an adverse immune response.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level II, prognostic prospective cohort study (patients enroled at different stages of disease progression).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jeo2.70906","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T15:59:01Z","timestamp":1790697541000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Three injections of freeze\u2010dried platelet factor concentrate provide greater clinical response than single injection in the treatment of knee osteoarthritis"],"prefix":"10.1002","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6834-6337","authenticated-orcid":false,"given":"Tadahiko","family":"Ohtsuru","sequence":"first","affiliation":[{"name":"Omiya Knee Osteoarthritis Clinic Saitama Japan"},{"name":"Ohtsuru Orthopedic Clinic Shizuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroto","family":"Hanai","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Graduate School of Medicine Osaka University Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taro","family":"Akimori","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Graduate School of Medicine Osaka University Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wataru","family":"Ando","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Graduate School of Medicine Osaka University Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norimasa","family":"Nakamura","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Graduate School of Medicine Osaka University Osaka Japan"},{"name":"Institute for Medical Science in Sports Osaka Health Sciences University Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4549-3817","authenticated-orcid":false,"given":"Stephen","family":"Lyman","sequence":"additional","affiliation":[{"name":"Department of Medical Education Kyushu University School of Medicine Fukuoka City Japan"},{"name":"Department of Population Health Sciences Weill Cornell Medical College New York New York 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