Abstract
Purpose
To systematically review the literature in order to compare the efficacy and safety
of platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC), and hyaluronic
acid (HA) injections for the treatment of knee osteoarthritis (OA).
Methods
A systematic review was performed by searching PubMed, the Cochrane Library, and Embase
to identify Level I studies that compared the clinical efficacy of at least 2 of the
following 3 injection therapies: PRP, BMAC, and HA for knee OA. The search phrase
used was knee AND osteoarthritis AND randomized AND (“platelet rich plasma” OR “bone marrow
aspirate” OR “hyaluronic acid”). Patients were primarily assessed based on patient-reported outcome scores (PROs)
including the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC),
visual analog scale (VAS) for pain, and Subjective International Knee Documentation
Committee (IKDC) score.
Results
Twenty-seven studies (all Level I) met inclusion criteria, including 1,042 patients
undergoing intra-articular injection(s) with PRP (mean age 57.7 years, mean follow-up
13.5 months), 226 patients with BMAC (mean age 57.0 years, mean follow-up 17.5 months),
and 1,128 patients with HA (mean age 59.0 years, mean follow-up 14.4 months). Non-network
meta-analyses demonstrated significantly better post-injection WOMAC (p < 0.001),
VAS (p < 0.01), and Subjective IKDC scores (p < 0.001) in PRP patients when compared
to HA patients. Similarly, network meta-analyses demonstrated significantly better
post-injection WOMAC (p < 0.001), VAS (p = 0.03), and Subjective IKDC (p < 0.001)
scores in BMAC patients when compared to HA patients. There were no significant differences
in post-injection outcome scores when comparing PRP to BMAC.
Conclusion
Patients undergoing treatment for knee OA with PRP or BMAC can be expected to experience
improved clinical outcomes when compared to HA patients.
Level of Evidence
I, Meta-Analysis of Level I studies
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Article info
Publication history
Accepted:
March 1,
2023
Received in revised form:
February 13,
2023
Received:
November 16,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Published by Elsevier on behalf of the Arthroscopy Association of North America
