Efficacy Of Platelet-Rich Plasma In The Treatment Of Knee Osteoarthritis: A Systematic Review And Meta-Analysis

Purpose: The purpose of this study was to use meta-analysis techniques to evaluate the efficacy and safety of platelet-rich plasma(PRP)injections for knee osteoarthritis(OA)treatment.Methods: We performed a systematic literature search in Pub Med,Embase,Scopus and the Cochrane database through April 2016 to identify Level I randomized controlled trials(RCTs)that evaluated the clinical efficacy of PRP versus control treatments for knee OA.The primary outcomes were WOMAC pain and function scores.The primary outcomes were compared with their minimum clinically important differences(MCID)—defined as the smallest difference perceived as important by the average patient.Results: We included 10 RCTs with a total of 1069 patients.Our analysis showed that at 6 months post-injection,PRP and hyaluronic acid(HA)had similar effects with respect to pain relief(WOMAC pain score)and functional improvement(WOMAC function score,WOMAC total score,IKDC score,Lequesne score).However,at 12 months post-injection,PRP was associated with significantly better pain relief(WOMAC pain score,mean difference(MD):-2.83,95% confidence interval(CI):-4.26 to-1.39,P = 0.0001)and functional improvement(WOMAC function score,MD:-12.53,95% CI:-14.58 to-10.47,P ? 0.00001;WOMAC total score,IKDC score,Lequesne score,standardized mean difference(SMD): 1.05,95% CI: 0.21 to 1.89,P = 0.01)than HA,and the effect sizes of WOMAC pain and function scores at 12 months exceeded the MCID(-0.79 for WOMAC pain and-2.85 for WOMAC function score).Compared with saline,PRP was more effective for pain relief(WOMAC pain score)and functional improvement(WOMAC function score)at 6 months and 12 months post-injection,and the effect sizes of WOMAC pain and function scores at 6 months and 12 months exceeded the MCID.We also found that PRP did not increase the risk of adverse events compared with HA and saline.Conclusions: Current evidence indicates that,compared with HA and saline,intra-articular PRP injection may have more benefit in pain relief and functional improvement in patients with symptomatic knee OA at one year post-injection.Level of Evidence: Level I,meta-analysis of Level I studies.