Platelet-Rich Plasma Versus Hyaluronic Acid for Knee Osteoarthritis: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Abstract

Background: Platelet-rich plasma (PRP) and hyaluronic acid (HA) are 2 nonoperative treatment options for knee osteoarthritis (OA) that are supposed to provide symptomatic relief and help delay surgical intervention. Purpose: To systematically review the literature to compare the efficacy and safety of PRP and HA injections for the treatment of knee OA. Study Design: Meta-analysis of level 1 studies. Methods: A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to identify level 1 studies that compared the clinical efficacy of PRP and HA injections for knee OA. The search phrase used was platelet-rich plasma hyaluronic acid knee osteoarthritis randomized. Patients were assessed via the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analog scale (VAS) for pain, and Subjective International Knee Documentation Committee (IKDC) scale. A subanalysis was also performed to isolate results from patients who received leukocyte-poor and leukocyte-rich PRP. Results: A total of 18 studies (all level 1) met inclusion criteria, including 811 patients undergoing intra-articular injection with PRP (mean age, 57.6 years) and 797 patients with HA (mean age, 59.3 years). The mean follow-up was 11.1 months for both groups. Mean improvement was significantly higher in the PRP group (44.7%) than the HA group (12.6%) for WOMAC total scores ( P < .01). Of 11 studies based on the VAS, 6 reported PRP patients to have significantly less pain at latest follow-up when compared with HA patients ( P < .05). Of 6 studies based on the Subjective IKDC outcome score, 3 reported PRP patients to have significantly better scores at latest follow-up when compared with HA patients ( P < .05). Finally, leukocyte-poor PRP was associated with significantly better Subjective IKDC scores versus leukocyte-rich PRP ( P < .05). Conclusion: Patients undergoing treatment for knee OA with PRP can be expected to experience improved clinical outcomes when compared with HA. Additionally, leukocyte-poor PRP may be a superior line of treatment for knee OA over leukocyte-rich PRP, although further studies are needed that directly compare leukocyte content in PRP injections for treatment of knee OA.

Platelet-Rich Plasma: New Performance Understandings and Therapeutic Considerations in 2020

“…The term orthobiologics has recently been introduced for the treatment of musculoskeletal (MSK) disorders, with promising results for the regenerative capacity of the heterogeneous biological active PRP cellular cocktail. Currently, PRP therapies are suitable treatment options with clinical benefits, with encouraging patient outcomes reported [ 2 , 3 , 4 ]. However, inconsistencies in patient outcomes and new insights have challenged the practicality of PRP clinical applications [ 5 , 6 , 7 ].…”

Phase II multicenter randomized controlled clinical trial on the efficacy of intra-articular injection of autologous bone marrow mesenchymal stem cells with platelet rich plasma for the treatment of knee osteoarthritis

“…The main characteristics that define it are its concentration of platelets two to threefold higher than the levels in blood and the absence of leukocytes. This makes PRGF ® a type of PRP that is poor in leukocytes, which are increasingly recommended for treating pathologies such as osteoarthritis, since promotes extracellular matrix repair, decreases inflammation, and slow-down joint degeneration [38].…”

Phase II Multicenter Randomized Controlled Clinical Trial on the Efficacy of Intra-articular Injection of Autologous Bone Marrow Mesenchymal Stem Cells with Platelet Rich Plasma for the Treatment of Knee Osteoarthritis

“…The main characteristics that de ne it are its concentration of platelets 2-3-fold higher than the levels in blood and the absence of leukocytes. This makes PRGF ® a type of PRP that is poor in leukocytes, which are increasingly recommended for treating pathologies such as osteoarthritis, since promotes extracellular matrix repair, decreases in ammation, and slow-down joint degeneration [38].…”