Intra-articular platelet-rich plasma injection for knee osteoarthritis: a summary of meta-analyses

Abstract

Objective: The purpose of this study was (1) to perform a summary of meta-analyses comparing platelet-rich plasma (PRP) injection with hyaluronic acid (HA) and placebo injection for KOA patients, (2) to determine which meta-analysis provides the best available evidence to making proposals for the use of PRP in the treatment of KOA patients, and (3) to highlight gaps in the literature that require future investigation. Material and methods: PubMed, EMBASE, and Cochrane databases search were performed for meta-analyses which compared PRP injection with HA or placebo. Clinical outcomes and adverse events were extracted from these meta-analyses. Meta-analysis quality was assessed using the Quality of Reporting of Meta-analyses (QUOROM) systems and the Oxman-Guyatt quality appraisal tool. The Jadad decision algorithm was also used to determine which meta-analysis provided the best available evidence. Results: Four meta-analyses were included in our study, and all of these articles were Level I evidence. The QUOROM score of each included meta-analysis range from 14 to 17 points (mean score 15, maximum score 18), and the Oxman-Guyatt score range from 4 to 6 points (mean score 5, maximum score 7). Three meta-analyses indicated PRP showed more benefit in pain relief and functional improvement than the control group, and the other one suggested no difference between these groups. All included meta-analyses found no statistical difference in adverse events between these groups. In addition, a meta-analysis conducted by Shen et al. got the highest methodological quality score and suggested that PRP provided better pain relief and function improvement in the treatment of KOA. Conclusions: For short-term follow-up (≤1 year), intra-articular PRP injection is more effective in terms of pain relief and function improvement in the treatment of KOA patients than HA and placebo, and there is no difference in the risk of an adverse event between PRP and HA or placebo.

Effects and safety of the combination of platelet-rich plasma (PRP) and hyaluronic acid (HA) in the treatment of knee osteoarthritis: a systematic review and meta-analysis

“…In recent years, there have been an increasing number of studies on the application of intraarticular injection of platelet-rich plasma (PRP) or hyaluronic acid (HA) in the treatment of KOA. Many systematic reviews suggest that intra-articular injection of PRP, compared to HA, can alleviate pain symptoms and improve knee function in patients with KOA [6,8,9]. However, a double-blind randomized controlled trial with a 5-year follow-up showed that the combination of HA and PRP improved pain and function in patients with a history of chronic symptomatic knee degenerative changes and osteoarthritis [10].…”

Extraction and identification of synovial tissue-derived exosomes by different separation techniques

“…Osteoarthritis (OA) is a musculoskeletal disease characterized by synovial inflammation, progressive cartilage wear, and subchondral bone hyperplasia [1,2]. It was reported that OA is one of the top ten causes of lower limb disability [3,4]. For many years, cartilage damage has been considered to be the main pathogenesis of OA.…”

Platelet-rich plasma versus hyaluronic acid in the treatment of knee osteoarthritis: a meta-analysis

“…Injections of intra-articular hyaluronic acid (HA) and platelet-rich plasma (PRP) are used as other non-surgical treatment options for the patients with KOA [11]. HA, a high-molecular weight glucosamine, is generated by chondrocytes, synoviocytes, and fibroblasts and responsible for the viscoelasticity and lubrication of the knee joint [12]. It is shown that HA concentrations in osteoarthritic knees have been reduced.…”