Platelet-Rich Plasma Provides Small but Superior Short-term Pain Relief and Functional Improvement Compared With Hyaluronic Acid for the Treatment of Knee Osteoarthritis: A Systematic Review and Meta-analysis.
Chenguang Zhong, Kunhao Wang, Xing Hu et al.
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In 30 seconds
This systematic review and meta-analysis compared intra-articular platelet-rich plasma (PRP) with hyaluronic acid (HA) for knee osteoarthritis, pooling 21 randomized controlled trials involving 1,790 patients. PRP did not significantly improve visual analog scale pain scores over HA at 3 or 6 months, but at 12 months it was associated with lower pain (standardized mean difference 0.76, P = .016). Western Ontario and McMaster Universities Osteoarthritis Index scores favored PRP at all assessed time points, while Knee Injury and Osteoarthritis Outcome Score and International Knee Documentation Committee outcomes did not differ significantly.
Key findings
- At 12 months, PRP reduced pain compared with HA (standardized mean difference 0.76, P = .016); no significant pain advantage was found at 3 or 6 months.
- Western Ontario and McMaster Universities Osteoarthritis Index improvements favored PRP at all time points (P ≤ .001).
- Knee Injury and Osteoarthritis Outcome Score and International Knee Documentation Committee outcomes showed no significant differences between PRP and HA.
- Higher platelet concentration, leukocyte-rich preparations, and activated PRP were associated with better 12-month outcomes; injection frequency showed no consistent effect.
Why it matters
The findings suggest that PRP may offer modest pain and functional benefits over HA for knee osteoarthritis, particularly by 12 months, but the advantage is not consistent across outcome measures or earlier follow-up. Variation in PRP preparation may contribute to differing results, making the evidence relevant to interpreting comparative treatment studies while underscoring uncertainty about which preparations perform best.
What to keep in mind
The review reports substantial heterogeneity and risk of bias across studies, and outcomes were limited to follow-up of up to 12 months.