The Efficacy Of PRP And HA In The Treatment Of Knee Joint Cartilage Degeneration:a Meta Analysis

Objective1.To evaluate the efficacy of intra-articular injection of platelet-rich plasma(PRP)and hyaluronic acid(HA)in the treatment of early knee osteoarthritis(KOA)by meta-analysis,and to provide evidence for the clinical strategy selection in the treatment of early KOA.2.To explore the efficacy and safety of PRP in the treatment of early knee osteoarthritis.Methods1.The literature retrieval model was based on the PICOS program(Participant,Intervention,Comparator,Outcome,Study design).The inclusion and exclusion criteria was set up according to the content of this study.Comprehensive and accurate search of relevant literature database,resulting in relatively more complete literature,All relevant literature including Randomized controlled trials(RCTs)and controlled clinical trials(CCTs)were included in this study.2.Medline,The Cochrane Library,CNKI,WanFang Data were searched by computer.Chinese and English relevant orthopedic journals were retrieved by hand search.To investigate the effects of intra-articular injection of platelet-rich plasma and hyaluronic acid in the treatment of KOA,according to the inclusion criteria and exclusion criteria,the non-conforming literature was excluded.(WOMAC score,IKDC score,VAS score and adverse reaction)were used as meta-analysis indicators.According to Cochrane synergistic analysis,the data were collected from the literature and the data were extracted by three researchers.Method recommended by Cochrane network was used for systematic evaluation.3.The quality of the literature was evaluated according to Cochrane risk bias assessment tool,including the randomized grouping method,the hidden method,the blind method and the follow-up cases.According to the Cochrane system evaluation manual,the evaluation of the quality of the literature is divided into three grades,grade A,all the evaluation indicators are correct,the possibility of bias is small;grade B,only one indicator is not described,the probability of bias is moderate;grade C,Only one indicator is incorrect or unused,and the bias is highly probable.4.Meta-analysis was performed using Rev Man 5.3 software.The adverse events were count data.The odds ratio(OR)analysis and 95% CI were used as the combined effect.WOMAC,VAS and IKDC scores were quantitative data.The median deviation(MD)and its 95% CI were used as the combined effect.Statistical heterogeneity test was performed on the included study using the χ2 test(test level α = 0.1).(P> 0.1).If the results were heterogeneous(P ≤ 0.1),the random effect model was used to analyze the data.The heterogeneity of the included studies was based on I2 statistics.Results1.Literature search results,in accordance with the comprehensive search strategy search,get the relevant literature 772,including 421 in English,351 articles in Chinese.A total of 92 RCTs were screened out by reading the titles and abstracts.Thirteen RCTs and four CCTs were included in the final study.A total of 1763 patients.Including 13 articles in English and 4 papers in Chinese,published from2011 to 2016.2.Meta-analysis showed that intra-articular injection of platelet-rich plasma(PRP)in patients with KOA had a lower WOMAC score at 3 months compared with intraarticular injection of hyaluronic acid(HA)[MD=-5.18,95%CI(-9.43,-0.93),P=0.02],the WOMAC score was lower in the 6th month [MD=-9.06,95%CI(-14.80,-3.22),P=0.002].The IKDC score was higher in the6 th month [MD=4.72,95%CI(1.61,7.84),P=0.003].The IKDC score was higher in the12 th month [MD=3.28,95%CI(0.30,6.26),P=0.03].the VAS score was higher in the3 th month,[MD=-0.88,95%CI(-1.83,0.08),P<0.00001 and the VAS score was higher in the 6th month [MD=-0.98,95%CI(-1.64,-0.31),P=0.004].There were no significant differences in adverse reactions [RR=1.30,95%CI(0.71,2.37),P=0.39].Conclusion1.Intra-articular injection of PRP can improve early and mid-KOA,improve knee function,reduce knee pain;2.Joint injection of PRP in early and mid-KOA results in less adverse reactions and higher safety;3.Joint intra-articular injection of PRP treatment of early and mid-stage KOA than the joint has a better advantage compared with Joint injection of HA,it is worthy of clinical priority.