The temporal effect of platelet-rich plasma on pain and physical function in the treatment of knee osteoarthritis: systematic review and meta-analysis of randomized controlled trials

Abstract

Background: Quite a few randomized controlled trials (RCTs) investigating the efficacy of platelet-rich plasma (PRP) for the treatment of knee osteoarthritis (OA) have recently been published. Therefore, an updated systematic review was performed to evaluate the temporal effect of PRP on knee pain and physical function.

Methods: Pubmed, Embase, the Cochrane Library, and Scopus were searched for human RCTs comparing the efficacy and/or safety of P-R infiltration with other intra-articular injections. A descriptive summary and quality assessment were performed for all the studies finally included for analysis. For studies reporting outcomes concerning the Western Ontario and McMaster Universities Arthritis Index (WOMAC) or adverse events, a random-effects model was used for data synthesis.

Results: Fourteen RCTs, comprising 1423 participants, were included. The control included saline placebo, HA, ozone, and corticosteroids. The follow-up ranged from 12 weeks to 12 months. The risk of bias assessment showed that 4 studies were considered to have moderate risk of bias and 10 to have high risk of bias. Compared with control, PRP injections significantly reduced WOMAC pain subscores at 3, 6, and 12 months follow-up (p = 0.02, 0.004, 0.001, respectively); PR significantly improved WOMAC physical function subscores at 3, 6, and 12 months (p = 0.002, 0.01, 0.001, respectively); PRP also significantly improved total WOMAC scores at 3, 6, and 12 months (all p  0.001); nonetheless, PR did not significantly increase the risk of post-injection adverse events (RR, 1.40 [95% CI, 0.80 to 2.45],  = 59%, p = 0.24).

Conclusions: Intra-articular PR injections are probably more efficacious in the treatment of knee OA in terms of pain relief and self-reported function improvement at 3, 6, and 12 months follow-up compared with other injections, including saline placebo, HA, ozone, and corticosteroids.

Review registration: PROSPERO CRD42016045410. Registered on August 8, 2016.

Keywords: Platelet-rich plasma, Hyaluronic acid, Knee, Osteoarthritis, Systematic review

Longxiang Shen”, Tnig Yuan”, Shengbao Chen?, Xuetao Xe*i* and Changing Zhang’

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