Efficacy of platelet-rich plasma injections in osteoarthritis of the knee: a systematic review and meta-analysis

Abstract

BackgroundThe effectiveness of platelet-rich plasma (PRP) injections for osteoarthritis (OA) is still controversial. We investigated the effect of PRP injections in patients with knee OA based on decreasing pain, improving function, global assessment and changes regarding joint imaging. Methods We performed a comprehensive, systematic literature search in computerised databases (MEDLINE, EMBASE, CINAHL, CENTRAL, Web of Science and PEDro) until June 2014 for randomised or nonrandomised controlled trials. These were graded for risk of bias and a level of evidence was provided. If possible, meta-analysis was performed. Results Ten trials were included. In these, intraarticular PRP injections were more effective for pain reduction (mean difference (MD) −2.45; 95% CI −2.92 to −1.98; p value <0.00001 and MD −2.07; 95% CI −2.59 to −1.55; p value <0.00001, single and double PRP injections, respectively) compared with placebo at 6 months postinjection. Intra-articular PRP injections were compared with hyaluronic acid and showed a statistically significant difference in favour of PRP on pain reduction based on the visual analogue scale and numeric rating scale (standardised mean difference −0.92; 95% CI −1.20 to −0.63; p value <0.00001) at 6 months postinjection. Almost all trials revealed a high risk of bias. Conclusions On the basis of the current evidence, PRP injections reduced pain more effectively than did placebo injections in OA of the knee (level of evidence: limited due to a high risk of bias). This significant effect on pain was also seen when PRP injections were compared with hyaluronic acid injections (level of evidence: moderate due to a generally high risk of bias). Additionally, function improved significantly more when PRP injections were compared with controls (limited to moderate evidence). More large randomised studies of good quality and low risk of bias are needed to test whether PRP injections should be a routine part of management of patients with OA of the knee.

Unsatisfactory outcomes following unicompartmental knee arthroplasty in patients with partial thickness cartilage loss

“…Having failed non-operative treatment modalities, in three-quarters of cases their pain and functional scores are the same, if not worse than patients with more advanced structural changes 2 . In randomised studies arthroscopy has been shown not to help this group of patients and there is uncertainty over the role of nonoperative treatments including the use of corticosteroids, hyaluronic acid and platelet rich plasma [3][4][5][6] . As such these patients represent a significant clinical challenge and the optimum treatment of this group, including the role of expectant management, is unclear.…”

Valutazione Economica Sull'utilizzo Del Plasma Arricchito di PiastrineVsAcido Ialuronico Per il Trattamento Dell'osteoartrosi al Ginocchio. Scenario a 1 Anno e a 5 Anni

“…Diversi studi mostrano che il PRP ha un'efficacia superiore all'HA (34)(35)(36)(37)(38)(39)(40)(41)(42).…”

Osteoarthritis: Current Clinical Concept and Some Promising Therapeutic Approaches

“…Так, A. Laudy и соавт. [68] изучили данные 10 РКИ, в которых проводилось сравнение эффекта внутрисустав-ного введения ОТП, гиалуроновой кислоты (ГРК) и плаце-бо. В сравнении с физиологическим раствором, активный препарат обеспечивал достоверно лучшее уменьшение бо-ли: через 6 мес среднее отличие составляло -2,45 (95% ДИ от -2,92 до -1,98; p<0,00001) и -2,07 (95% ДИ от -2,59 до -1,55; p<0,00001) для однократной и повторных инъекций.…”