TY - JOUR
T1 - Patients With Knee Osteoarthritis Who Receive Platelet-Rich Plasma or Bone Marrow Aspirate Concentrate Injections Have Better Outcomes Than Patients Who Receive Hyaluronic Acid
T2 - Systematic Review and Meta-analysis
AU - Belk, John W.
AU - Lim, Joseph J.
AU - Keeter, Carson
AU - McCulloch, Patrick C.
AU - Houck, Darby A.
AU - McCarty, Eric C.
AU - Frank, Rachel M.
AU - Kraeutler, Matthew J.
N1 - Funding Information:
The authors report the following potential conflicts of interest or sources of funding: E.C.M. reports consultant for Biomet; royalties from Zimmer Biomet and Elsevier; and research support from Arthrex, Breg, DJ Orthopaedics, Mitek, Ossur, and Smith & Nephew, outside the submitted work. R.M.F. reports consultant and payment for lectures, including service on speakers bureaus for AlloSource, Arthrex, and JRF Ortho; royalties from Elsevier; and research support from Arthrex, Smith & Nephew, outside the submitted work. P.C.M. reports consultant for Arthrex and research support from Smith & Nephew, outside the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Publisher Copyright:
© 2023 Arthroscopy Association of North America
PY - 2023/7
Y1 - 2023/7
N2 - PURPOSE: To systematically review the literature to compare the efficacy and safety of platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC), and hyaluronic acid (HA) injections for the treatment of knee osteoarthritis (OA).METHODS: A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to identify Level I studies that compared the clinical efficacy of at least 2 of the following 3 injection therapies: PRP, BMAC, and HA for knee OA. The search phrase used was knee AND osteoarthritis AND randomized AND ("platelet rich plasma" OR "bone marrow aspirate" OR "hyaluronic acid"). Patients were primarily assessed based on patient-reported outcome scores (PROs) including the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analog scale (VAS) for pain, and Subjective International Knee Documentation Committee (IKDC) score.RESULTS: Twenty-seven studies (all Level I) met inclusion criteria, including 1,042 patients undergoing intra-articular injection(s) with PRP (mean age 57.7 years, mean follow-up 13.5 months), 226 patients with BMAC (mean age 57.0 years, mean follow-up 17.5 months), and 1,128 patients with HA (mean age 59.0 years, mean follow-up 14.4 months). Nonnetwork meta-analyses demonstrated significantly better postinjection WOMAC (P < .001), VAS (P < .01), and Subjective IKDC scores (P < .001) in patients who received PRP compared with patients who received HA. Similarly, network meta-analyses demonstrated significantly better postinjection WOMAC (P < .001), VAS (P = .03), and Subjective IKDC (P < .001) scores in patients who received BMAC compared with patients who received HA. There were no significant differences in postinjection outcome scores when comparing PRP with BMAC.CONCLUSIONS: Patients undergoing treatment for knee OA with PRP or BMAC can be expected to experience improved clinical outcomes when compared with patients who receive HA.LEVEL OF EVIDENCE: Level I, meta-analysis of Level I studies.
AB - PURPOSE: To systematically review the literature to compare the efficacy and safety of platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC), and hyaluronic acid (HA) injections for the treatment of knee osteoarthritis (OA).METHODS: A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to identify Level I studies that compared the clinical efficacy of at least 2 of the following 3 injection therapies: PRP, BMAC, and HA for knee OA. The search phrase used was knee AND osteoarthritis AND randomized AND ("platelet rich plasma" OR "bone marrow aspirate" OR "hyaluronic acid"). Patients were primarily assessed based on patient-reported outcome scores (PROs) including the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analog scale (VAS) for pain, and Subjective International Knee Documentation Committee (IKDC) score.RESULTS: Twenty-seven studies (all Level I) met inclusion criteria, including 1,042 patients undergoing intra-articular injection(s) with PRP (mean age 57.7 years, mean follow-up 13.5 months), 226 patients with BMAC (mean age 57.0 years, mean follow-up 17.5 months), and 1,128 patients with HA (mean age 59.0 years, mean follow-up 14.4 months). Nonnetwork meta-analyses demonstrated significantly better postinjection WOMAC (P < .001), VAS (P < .01), and Subjective IKDC scores (P < .001) in patients who received PRP compared with patients who received HA. Similarly, network meta-analyses demonstrated significantly better postinjection WOMAC (P < .001), VAS (P = .03), and Subjective IKDC (P < .001) scores in patients who received BMAC compared with patients who received HA. There were no significant differences in postinjection outcome scores when comparing PRP with BMAC.CONCLUSIONS: Patients undergoing treatment for knee OA with PRP or BMAC can be expected to experience improved clinical outcomes when compared with patients who receive HA.LEVEL OF EVIDENCE: Level I, meta-analysis of Level I studies.
KW - Humans
KW - Middle Aged
KW - Hyaluronic Acid/therapeutic use
KW - Osteoarthritis, Knee/drug therapy
KW - Bone Marrow
KW - Treatment Outcome
KW - Injections, Intra-Articular
KW - Platelet-Rich Plasma
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U2 - 10.1016/j.arthro.2023.03.001
DO - 10.1016/j.arthro.2023.03.001
M3 - Review article
C2 - 36913992
AN - SCOPUS:85153321402
SN - 0749-8063
VL - 39
SP - 1714
EP - 1734
JO - Arthroscopy - Journal of Arthroscopic and Related Surgery
JF - Arthroscopy - Journal of Arthroscopic and Related Surgery
IS - 7
ER -