Platelet-rich plasma for knee osteoarthritis: a systematic review and meta-analysis of structural outcomes.
Eric Pasqualotto, Tales Pasqualotto, Laura Lunelli et al.
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In 30 seconds
This systematic review and meta-analysis assessed imaging-based structural outcomes after platelet-rich plasma (PRP) treatment in people with knee osteoarthritis. It included 12 randomized controlled trials involving 1,200 patients. Compared with control treatments, PRP was associated with greater improvement in patellofemoral cartilage thickness or volume (SMD 0.94; 95% CI, 0.53 to 1.34) and reduced bone marrow edema (SMD - 0.40; 95% CI, - 0.71 to - 0.09). Other assessed structural outcomes showed no significant or consistent benefit, leading the authors to conclude that evidence does not clearly support PRP as a structural disease-modifying treatment.
Key findings
- PRP was associated with greater improvement in patellofemoral cartilage thickness or volume than control (SMD 0.94; 95% CI, 0.53 to 1.34).
- Bone marrow edema was reduced with PRP (SMD - 0.40; 95% CI, - 0.71 to - 0.09).
- No significant differences were found for medial tibial cartilage measurements, cartilage defect progression, WORMS osteophytes or subchondral cysts.
- Synovitis did not differ overall between groups (SMD - 0.22; 95% CI, - 0.43 to 0.00).
Why it matters
Imaging outcomes help assess whether an intervention may alter joint structure, beyond any symptomatic effects. Across the included trials, PRP’s favorable findings were limited to selected measures, while most structural outcomes did not show consistent benefit. This distinction is important when interpreting PRP as a potential disease-modifying treatment rather than assuming that improvement in one imaging measure reflects broader structural protection.
What to keep in mind
The review reports limited and inconsistent effects across imaging outcomes and calls for additional high-quality trials using standardized imaging endpoints.