Efficacy of Platelet-Rich Plasma in the Treatment of Knee Osteoarthritis: A Meta-analysis of Randomized Controlled Trials

Abstract

To use meta-analysis techniques to evaluate the efficacy and safety of platelet-rich plasma (PRP) injections for the treatment knee of osteoarthritis (OA). We performed a systematic literature search in PubMed, Embase, Scopus, and the Cochrane database through April 2016 to identify Level I randomized controlled trials that evaluated the clinical efficacy of PRP versus control treatments for knee OA. The primary outcomes were Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function scores. The primary outcomes were compared with their minimum clinically important differences (MCID)-defined as the smallest difference perceived as important by the average patient. We included 10 randomized controlled trials with a total of 1069 patients. Our analysis showed that at 6months postinjection, PRP and hyaluronic acid (HA) had similar effects with respect to pain relief (WOMAC pain score) and functional improvement (WOMAC function score, WOMAC total score, International Knee Documentation Committee score, Lequesne score). At 12months postinjection, however, PRP was associated with significantly better pain relief (WOMAC pain score, mean difference-2.83, 95% confidence interval [CI]-4.26 to-1.39, P= .0001) and functional improvement (WOMAC function score, mean difference-12.53, 95% CI-14.58 to-10.47, P < .00001; WOMAC total score, International Knee Documentation Committee score, Lequesne score, standardized mean difference 1.05, 95% CI 0.21-1.89, P= .01) than HA, and the effect sizes of WOMAC pain and function scores at 12months exceeded the MCID (-0.79 for WOMAC pain and-2.85 for WOMAC function score). Compared with saline, PRP was more effective for pain relief (WOMAC pain score) and functional improvement (WOMAC function score) at 6months and 12months postinjection, and the effect sizes of WOMAC pain and function scores at 6months and 12months exceeded the MCID. We also found that PRP did not increase the risk of adverse events compared with HA and saline. Current evidence indicates that, compared with HA and saline, intra-articular PRP injection may have more benefit in pain relief and functional improvement in patients with symptomatic knee OA at 1 year postinjection. Level I, meta-analysis of Level I studies.