Purpose
To use meta-analysis techniques to evaluate the efficacy and safety of platelet-rich
plasma (PRP) injections for the treatment knee of osteoarthritis (OA).
Methods
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.
Results
We included 10 randomized controlled trials with a total of 1069 patients. Our analysis
showed that at 6 months 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 12 months 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 12 months
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 6 months and 12 months postinjection, and the
effect sizes of WOMAC pain and function scores at 6 months and 12 months exceeded
the MCID. We also found that PRP did not increase the risk of adverse events compared
with HA and saline.
Conclusions
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 of Evidence
Level I, meta-analysis of Level I studies.
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Article info
Publication history
Published online: December 22, 2016
Accepted:
September 22,
2016
Received:
May 31,
2016
Footnotes
See commentary on page 671
The authors report that they have no conflicts of interest in the authorship and publication of this article.
Identification
Copyright
© 2016 Published by Elsevier on behalf of the Arthroscopy Association of North America
