Purpose
To evaluate the efficacy of platelet-rich plasma (PRP) combined with hyaluronic acid
(HA) injections versus HA injections alone for the management of knee osteoarthritis
(OA).
Methods
This study was performed according to the Preferred Reporting Items for Systematic
Reviews and Meta-Analyses guidelines. Eligible randomized-controlled trials and observational
studies directly comparing combined PRP-HA injections with HA injections alone were
identified through a search of PubMed, Scopus, and Cochrane Central databases from
inception to May 2020. A random effects model meta-analysis was conducted and the
I2 statistic was used to assess for heterogeneity.
Results
Four studies comprising 377 patients (PRP-HA: 193, HA: 184) with knee OA ranging from
I-IV Kellgren–Lawrence grading scale were included. The final follow-up was 12 months
in 3 studies and 6 months in 1 study. Patients who received PRP combined with HA had
significantly greater improvements compared with those injected with HA alone in terms
of visual analog scale scores at 3-month (standardized mean difference [SMD] 1.13;
95% confidence interval [CI] 0.56-1.70; I2 = 56.7%; P < .001), 6-month (SMD 1.08; 95% CI 0.54-1.62; I2 = 67.9%; P < .001), and 12-month (SMD 1.13; 95% CI 0.74-1.52; I2 = 0.0%; P < .001) and 12-month Western Ontario and McMaster Universities Osteoarthritis Index
(WOMAC) physical functioning (SMD 0.91; 95% CI 0.65-1.17; I2 = 0.0%; P < .001) and 12-month WOMAC stiffness (SMD 1.09; 95% CI 0.80-1.38; I2 = 0.0%; P < .001) scores. No difference was identified in terms of 12-month WOMAC pain score
(SMD 0.36; 95% CI –0.19 to 0.91; I2 = 74.1%; P = .195).
Conclusions
Symptomatic patients with knee OA who were injected with a combination of PRP and
HA demonstrated greater improvement in pain and function compared with patients who
received HA injections only, as assessed by 3-, 6-, and 12-month visual analog scale
scores and 12-month WOMAC physical function and stiffness scores. This study provides
encouraging evidence for the use of the combined PRP-HA injections in the management
of symptomatic patients with knee OA.
Level of Evidence
III (meta-analysis of randomized and non-randomized comparative trials).
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Article info
Publication history
Published online: December 02, 2020
Accepted:
November 19,
2020
Received:
May 21,
2020
Footnotes
See commentary on page 1277
The authors report the following potential conflicts of interest or sources of funding: B.J.C. reports grants, personal fees, and nonfinancial support from Arthrex, during the conduct of the study; and other from Aesculap and Athletico, personal fees and other from Elsevier Publishing, other from JRF Ortho and the National Institutes of Health, personal fees and other from OTSM, personal fees from Ossio and Regentis, and other from Smith & Nephew, outside the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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© 2020 by the Arthroscopy Association of North America. Published by Elsevier. All rights reserved.
