Multiple Injections of Platelet-Rich Plasma Versus Hyaluronic Acid for Knee Osteoarthritis: A Systematic Review and Meta-Analysis of Current Evidence in Randomized Controlled Trials

Abstract

In recent years, various clinical trials have focused on treating knee osteoarthritis (KOA) with multiple injections of platelet-rich plasma (PRP). However, compared with the multiple hyaluronic acid (m-HA) injections, the clinical efficacy of multiple PRP (m-PRP) injections for KOA still remains controversial among these studies. Therefore,we aimed to compare the clinical effectiveness of m-PRP injections with m-HA injections in the treatment of KOA in this systematic review. Relevant clinical trials were searched via bibliographic databases, including Medline, PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials, to compare the m-PRP and m-HA injections in the treatment of KOA. Finally, fourteen randomized controlled trials, including 1512 patients, showed the postoperative VAS, WOMAC, IKDC, or EQ-VAS scores and were enrolled in this systematic review. Compared with the group of intra-articular m-HA injections, the group of intra-articular m-PRP injections was lower in the VAS scores at 3-month (WMD = −0.25; 95%CI, −0.40 to −0.10, P = 0.0009) and 12-month (WMD = −0.64; 95%CI, −0.79 to −0.49, p < 0.00001) follow-ups. In addition, the group of intra-articular m-PRP injections was also lower in the WOMAC scores at 1-month (WMD = −1.23; 95%CI, −2.17 to −0.29, p = 0.01), 3-month (WMD = −5.34; 95%CI, −10.41 to −0.27, p = 0.04), 6-month (WMD = −11.02; 95%CI, −18.09 to −3.95, p = 0.002), and 12-month (WMD = −7.69; 95%CI, −12.86 to −2.52, p = 0.004) follow-ups. Furthermore, compared with the group of intra-articular m-HA injections, the group of intra-articular m-PRP injections was higher in the IKDC scores at 3-month (WMD = 7.45; 95%CI, 2.50 to 12.40, p = 0.003) and 6-month (WMD = 5.06; 95%CI, 1.94 to 8.18, p = 0.001) follow-ups. However, the long-term adverse side of m-PRP injections for KOA still needs more large-scale trials and long-term follow-ups.

Effects of Adding Extracorporeal Shockwave Therapy (ESWT) to Platelet-Rich Plasma (PRP) among Patients with Rotator Cuff Partial Tear: A Prospective Randomized Comparative Study

“…PRP is a concentrated solution of platelets that is rich in growth factors, showing the ability to facilitate angiogenesis, neuroprotection, neural regeneration, regulation of inflammation with broad therapeutic applications [17,[32][33][34][35][36][37][38][39][40][41][42]. Comparative studies have shown the clinical advantages of PRP injection for patients with incomplete RC tears.…”

Clinical Outcome of Multiple Platelet-Rich Plasma Injection and Correlation with PDGF-BB in the Treatment of Knee Osteoarthritis

“…A meta-analysis of 463 patients also found that patients who received the m-PRP injections had significantly lower scores on VAS and WOMAC than patients who received the m-HA injections. A RCT involving 162 participants revealed that administering multiple PRP injections is more efficacious than single injections and hyaluronic acid in treating early osteoarthritis in the knees [25,30,31].…”

A Review of the Role of Platelet-Rich Plasma in Fracture Healing

“…PRP solution contains a concentration of platelets 3 to 8 times higher than that of normal blood, which provides several theoretical advantages for tissue regeneration during various pathological conditions 30 . Recent clinical studies have demonstrated the efficacy of PRP infusion in treating chronic diabetic ulcers 31 , osteoarthritis of the knee joint 32 , plantar fasciitis 33 , and even military drill injuries 4 . Moreover, since PRP solution also contains white blood cells in sufficient quantity, it is believed to enhance the body's defense against local inflammation and its attempt to eliminate local pathogenic microorganisms 34 .…”

“…These components give PRP important biological properties that can aid in tissue repair and regeneration, and improve local microcirculation in the area where it is injected 5 . As a minimally invasive method, in recent years it has found important therapeutic applications in various pathological conditions that involve multiple medical specialties, such as orthopaedics 6 , rheumatology 7 , plastic surgery 8 and dermatology 9 .…”