Abstract
ObjectiveThe 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 methodsPubMed, 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.ResultsFour 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.ConclusionsFor 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.Level of evidenceLevel I evidence, a summary of meta-analysesTrial registrationPROSPERO ID CRD42018116168
Highlights
Knee osteoarthritis (KOA) is one of the most common degenerative joint diseases with continuous pain and loss of function [1] and characterized by progressive loss of articular cartilage, inflammation of synovial membrane, and changes in the bones under the cartilage [2,3,4,5]
A meta-analysis conducted by Shen et al got the highest methodological quality score and suggested that platelet-rich plasma (PRP) provided better pain relief and function improvement in the treatment of KOA
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 hyaluronic acid (HA) and placebo, and there is no difference in the risk of an adverse event between PRP and HA or placebo
Summary
Knee osteoarthritis (KOA) is one of the most common degenerative joint diseases with continuous pain and loss of function [1] and characterized by progressive loss of articular cartilage, inflammation of synovial membrane, and changes in the bones under the cartilage [2,3,4,5]. Total knee arthroplasty (TKA) is regarded as the last choice if osteoarthritis progresses to end-stage [8], there is a significant risk of complications including revision, infection, and unsatisfied function [8,9,10]. Various growth factors and cytokines are released after the degranulation of platelets and to accelerate cartilage matrix synthesis, restrain synovial membrane inflammation, and promote cartilage healing [17, 18]. Owing to the properties of regenerative effect and anti-inflammatory potential, PRP is widely used in musculoskeletal diseases, such as rotator cuff tear, lateral epicondylitis, patellar tendinopathy, osteoarthritis [19,20,21,22,23,24,25,26]
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