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

@article{Belk2020PlateletRichPV,
  title={Platelet-Rich Plasma Versus Hyaluronic Acid for Knee Osteoarthritis: A Systematic Review and Meta-analysis of Randomized Controlled Trials},
  author={John W. Belk and Matthew J. Kraeutler and Darby A. Houck and Jesse A. Goodrich and Jason Louis Dragoo and Eric C McCarty},
  journal={The American Journal of Sports Medicine},
  year={2020},
  volume={49},
  pages={249 - 260}
}
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… 
Platelet-Rich Plasma versus Hyaluronic Acid for Hip Osteoarthritis Yield Similarly Beneficial Short-Term Clinical Outcomes: A Systematic Review and Meta-Analysis of Level I and II Randomized Controlled Trials.
  • J. W. Belk, Darby A. Houck, E. McCarty
  • Medicine
    Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association
  • 2021
Comparing Intra-articular Injections of Leukocyte-Poor Platelet-Rich Plasma Versus Low–Molecular Weight Hyaluronic Acid for the Treatment of Symptomatic Osteoarthritis of the Hip: A Double-Blind, Randomized Pilot Study
TLDR
Intra-articular hip injections of LP-PRP in patients with hip OA resulted in an improvement in WOMAC scores and hip internal rotation at 6 months and delayed the need for THA or a hip resurfacing procedure compared with treatment with LMW-HA.
The use of platelet-rich plasma in studies with early knee osteoarthritis versus advanced stages of the disease: a systematic review and meta-analysis of 31 randomized clinical trials
TLDR
The results indicate that including patients with advanced knee OA does not seem to affect the outcomes of clinical trials in which the effectiveness of the PRP in knee Oa is assessed, and a meta-analysis for pain and functional improvement showed a significant pain relief in studies with 1–3 and 1–4 Kellgren–Lawrence OA stages and a significant functional improvement in studies, favoring PRP.
Intra-articular injection of Platelet rich plasma versus Hyaluronic acid for moderate knee osteoarthritis. A prospective, double-blind randomized controlled trial on 189 patients with follow-up for three years.
TLDR
Both platelet rich plasma and Hyaluronic acid were effective in improving knee Symptoms and functional status over time and remained stable over time up to 18 months Post-injection.
Relative Efficacy of Intra-articular Injections in the Treatment of Knee Osteoarthritis: A Systematic Review and Network Meta-analysis.
TLDR
PRP yielded improved outcomes when compared with PRGF, HA, CS, and placebo for the treatment of symptomatic knee OA at a minimum 6-month follow-up, and was found to possess the highest probability of efficacy.
Bone marrow aspirate concentrate versus platelet-rich plasma for treating knee osteoarthritis: a one-year non-randomized retrospective comparative study
TLDR
Intra-articular autologous BMAC injections are safe, effective in treating pain, and ameliorate functionality in patients with symptomatic knee OA to a greater extent than PRP injections.
Clinical Response After Treatment of Knee Osteoarthritis With a Standardized, Closed-System, Low-Cost Platelet-Rich Plasma Product: 1-Year Outcomes
TLDR
This standardized PRP production method resulted in improved WOMAC scores at 1 year postoperatively in 70% of patients with KOA and was safe and affordable and ensured consecutive infiltrations with the same product to each patient.
Effect of Intra-articular Platelet-Rich Plasma vs Placebo Injection on Pain and Medial Tibial Cartilage Volume in Patients With Knee Osteoarthritis: The RESTORE Randomized Clinical Trial.
TLDR
In patients with symptomatic mild to moderate radiographic knee OA, intra-articular injection of PRP, compared with injection of saline placebo, did not result in a significant difference in symptoms or joint structure at 12 months, and these findings do not support use ofPRP for the management of knee Oa.
Platelet-rich plasma injections delay the need for knee arthroplasty: a retrospective study and survival analysis
TLDR
It is suggested that the application of PRP in KOA patients is a treatment that could delay TKA, although further studies are needed to understand and improve this therapy.
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References

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Efficacy of Platelet-Rich Plasma in the Treatment of Knee Osteoarthritis: A Meta-analysis of Randomized Controlled Trials.
  • Wenxue Dai, Aiguo Zhou, Hua Zhang, Jian Zhang
  • Medicine
    Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association
  • 2017
Knee Osteoarthritis Injection Choices: Platelet- Rich Plasma (PRP) Versus Hyaluronic Acid (A one-year randomized clinical trial)
TLDR
It is suggested that PRP injection is more efficacious than HA injection in reducing symptoms and improving quality of life and is a therapeutic option in select patients with knee OA who have not responded to conventional treatment.
Platelet-Rich Plasma Versus Hyaluronic Acid Injections for the Treatment of Knee Osteoarthritis: Results at 5 Years of a Double-Blind, Randomized Controlled Trial
TLDR
To compare the long-term clinical outcomes provided by intra-articular injections of either PRP or hyaluronic acid to treat knee degenerative disease, PRP did not provide an overall superior clinical improvement compared with HA in terms of either symptomatic-functional improvement at different follow-up points or effect duration.
Hyaluronic Acid Versus Platelet-Rich Plasma: A Prospective, Double-Blind Randomized Controlled Trial Comparing Clinical Outcomes and Effects on Intra-articular Biology for the Treatment of Knee Osteoarthritis
TLDR
No difference was found between HA and PRP at any time point in the primary outcome measure: the patient-reported WOMAC pain score, which suggests that the anti-inflammatory properties of PRP may contribute to an improvement of symptoms.
Treatment of knee osteoarthritis: platelet-derived growth factors vs. hyaluronic acid. A randomized controlled trial
TLDR
Activated platelet-rich plasma reduces articular damage as evident at MRI, as soon as six months after treatment; it reduces pain and improves patient’s function and overall quality of life.
Randomized controlled trial comparing hyaluronic acid, platelet-rich plasma and the combination of both in the treatment of mild and moderate osteoarthritis of the knee
TLDR
The findings of the study support the use of autologous PRP as an effective treatment of mild to moderate knee osteoarthritis and suggest that combination of PRP and HA could potentially provide better functional outcomes in the first 30 days after treatment with both PRPand HA alone.
Intra-Articular Injections of Platelet-Rich Plasma versus Hyaluronic Acid in the Treatment of Osteoarthritic Knee Pain: A Randomized Clinical Trial in the Context of the Spanish National Health Care System
TLDR
PRP injection was proved to improve pain three months after the final infiltration and to be more effective in lower osteoarthritis grades, with results resembling those of the HA group at six months.
Intra-articular injection of photo-activated platelet-rich plasma in patients with knee osteoarthritis: a double-blind, randomized controlled pilot study
TLDR
This pilot study provides proof-of-concept evidence concerning the feasibility and safety of PA-PRP injections necessary to inform a larger clinical trial in people with knee OA and suggests photo-activated PRP may provide a safe and effective novel treatment for knees OA.
Platelet-Rich Plasma for the Management of Hip and Knee Osteoarthritis
TLDR
Results showed that PRP is a safe treatment with potential to provide symptomatic benefit for OA at least in the short term (up to 12 months), and younger patients with less severe disease may be more responsive.
Intra-articular Injection of Platelet-Rich Plasma Is Superior to Hyaluronic Acid or Saline Solution in the Treatment of Mild to Moderate Knee Osteoarthritis: A Randomized, Double-Blind, Triple-Parallel, Placebo-Controlled Clinical Trial.
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