Purpose
The purpose of this systematic review was to synthesize the available Level I and
Level II literature on platelet-rich plasma (PRP) as a therapeutic intervention in
the management of symptomatic knee osteoarthritis (OA).
Methods
A systematic review of Medline, Embase, Cochrane Central Register of Controlled Trials,
PubMed, and www.clinicaltrials.gov was performed to identify all randomized controlled trials and prospective cohort
studies that evaluated the clinical efficacy of PRP versus a control injection for
knee OA. A random-effects model was used to evaluate the therapeutic effect of PRP
at 24 weeks by use of validated outcome measures (Western Ontario and McMaster Universities
Arthritis Index, visual analog scale for pain, International Knee Documentation Committee
Subjective Knee Evaluation Form, and overall patient satisfaction).
Results
Six Level I and II studies satisfied our inclusion criteria (4 randomized controlled
trials and 2 prospective nonrandomized studies). A total of 577 patients were included,
with 264 patients (45.8%) in the treatment group (PRP) and 313 patients (54.2%) in
the control group (hyaluronic acid [HA] or normal saline solution [NS]). The mean
age of patients receiving PRP was 56.1 years (51.5% male patients) compared with 57.1
years (49.5% male patients) for the group receiving HA or NS. Pooled results using
the Western Ontario and McMaster Universities Arthritis Index scale (4 studies) showed
that PRP was significantly better than HA or NS injections (mean difference, −18.0
[95% confidence interval, −28.8 to −8.3]; P < .001). Similarly, the International Knee Documentation Committee scores (3 studies)
favored PRP as a treatment modality (mean difference, 7.9 [95% confidence interval,
3.7 to 12.1]; P < .001). There was no difference in the pooled results for visual analog scale score
or overall patient satisfaction. Adverse events occurred more frequently in patients
treated with PRP than in those treated with HA/placebo (8.4% v 3.8%, P = .002).
Conclusions
As compared with HA or NS injection, multiple sequential intra-articular PRP injections
may have beneficial effects in the treatment of adult patients with mild to moderate
knee OA at approximately 6 months. There appears to be an increased incidence of nonspecific
adverse events among patients treated with PRP.
Level of evidence
Level II, systematic review of Level I and II studies.
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Article info
Publication history
Accepted:
September 11,
2013
Received:
April 16,
2013
Footnotes
The authors report the following potential conflict of interest or source of funding: T.L. and D.L. receive support from grants pending from Physicians Services Foundation Inc as Principal Investigator and grants received from Orthopaedic Trauma Association as both Principal Investigator and a co-investigator. J.T. receives support from Zimmer, Linvatec, and Smith & Nephew. R.G. receives support from Smith & Nephew.
Identification
Copyright
© 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
