Platelet-rich Plasma Superiority over Hyaluronic Acid as a Conservative Treatment for Early Knee Osteoarthritis: A Systematic Review

Gian Ivander; Albert Riantho; Yovita Anggono

doi:10.3889/oamjms.2024.11860

Authors

Gian Ivander Department of Orthopaedics and Traumatology, Widya Mandala Catholic University, Faculty of Medicine, Indonesia; Department of Orthopaedics and Traumatology, Siloam Hospitals Lippo Village, Tangerang, Indonesia https://orcid.org/0009-0002-3817-8544
Albert Riantho Department of Orthopaedics and Traumatology, Pelita Harapan University, Faculty of Medicine, Tangerang, Indonesia; Department of Orthopaedics and Traumatology, Siloam Hospitals Lippo Village, Tangerang, Indonesia https://orcid.org/0000-0002-2317-3559
Yovita Anggono Department of Orthopaedics and Traumatology, Widya Mandala Catholic University, Faculty of Medicine, Indonesia https://orcid.org/0009-0004-8794-7084

DOI:

https://doi.org/10.3889/oamjms.2024.11860

Keywords:

platelet rich plasma, hyaluronic acid, knee osteoarthritis, conservative treatment

Abstract

AIM:This study aimed to perform a systematic review (SR) of SR to elucidate prior findings regarding favorable outcomes between platelet-rich plasma (PRP) and hyaluronic acid (HA) injections for early knee osteoarthritis (KOA).

MATERIALS AND METHODS: We conducted a thorough literature search adhering to the Preferred Reporting Items for SR and Meta-analyses only for SRs from PubMed, ScienceDirect, and Google Scholar from 2020 to 2023. The inclusion and exclusion criteria were determined using the population, intervention, comparison, outcome, and study design model. A measurement tool to assess SR-2 was used to grade the included SRs. Two researchers independently searched, extracted, and assessed the risk of bias in the included studies. Cohen’s kappa coefficient was used to calculate the inter-observer disparities in study eligibility and risk of bias. The corrected covered area (CCA) metric addressed the overlap issue with the original studies.

RESULTS: One SR yielded high methodological quality whereas three SRs yielded moderate methodological quality. The overall CCA among the four SRs was 30.77%, and all SRs used the Western Ontario and McMaster Universities Osteoarthritis Index score as a patient-reported outcome (PRO) and revealed that the PRP group improved more than the HA group. One SR used the Tegner score as a PRO and found no distinction between the PRP and HA groups. The incidence of substantial pain was lower in the PRP group than in the HA group. One SR reported considerably lower local pain post-injection in the HA groups. Overall, three SRs showed that PRP yielded better outcomes than the HA, and one showed that PRP showed advantages over HA injections for knee pain at 6 and 12 months; however, the clinical outcomes were not different.

CONCLUSION: Our findings supported the superiority of PRP over HA as a long-term alternative therapy for early-stage KOA.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Hsu H, Siwiec RM. Knee osteoarthritis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023. Available from: https:// www.ncbi.nlm.nih.gov/books/nbk507884 [Last accessed on 2023 Jun 26].

Coaccioli S, Sarzi-Puttini P, Zis P, Rinonapoli G, Varrassi G. Osteoarthritis: New insight on its pathophysiology. J Clin Med. 2022;11(20):6013. https://doi.org/10.3390/jcm11206013 PMid:36294334 DOI: https://doi.org/10.3390/jcm11206013

Bortoluzzi A, Furini F, Scirè CA. Osteoarthritis and its management-epidemiology, nutritional aspects and environmental factors. Autoimmun Rev. 2018;17(11):1097-104. https://doi.org/10.1016/j.autrev.2018.06.002 PMid:30213694 DOI: https://doi.org/10.1016/j.autrev.2018.06.002

Watkins-Castillo S, Andersson G. United States Bone and Joint Initiative: The Burden of Musculoskeletal Diseases in the United States (BMUS). Rosemont: American Academy of Orthopaedic Surgeons; 2014. p. 708. Available from: https://www.boneandjointburden.org

Lim WB,Al-Dadah O. Conservative treatment of knee osteoarthritis: A review of the literature. World J Orthop. 2022;13(3):212-29. https://doi.org/10.5312/wjo.v13.i3.212 PMid:35317254 DOI: https://doi.org/10.5312/wjo.v13.i3.212

Vannabouathong C, Bhandari M, Bedi A, Khanna V, Yung P, Shetty V, et al. Nonoperative treatments for knee osteoarthritis: An evaluation of treatment characteristics and the intra-articular placebo effect: A systematic review. JBJS Rev. 2018;6(7):e5. https://doi.org/10.2106/JBJS.RVW.17.00167 PMid:30020117 DOI: https://doi.org/10.2106/JBJS.RVW.17.00167

Ding JB, Hu K. Injectable therapies for knee osteoarthritis. Reumatologia. 2021;59(5):330-9. https://doi.org/10.5114/reum.2021.110612 PMid:34819708 DOI: https://doi.org/10.5114/reum.2021.110612

Dai WL, Zhou AG, Zhang H, Zhang J. Efficacy of platelet-rich plasma in the treatment of knee osteoarthritis: A meta-analysis of randomized controlled trials. Arthroscopy. 2017;33(3):659-70. e1. https://doi.org/10.1016/j.arthro.2016.09.024 PMid:28012636 DOI: https://doi.org/10.1016/j.arthro.2016.09.024

Filardo G, Di Matteo B, Kon E, Merli G, Marcacci M. Platelet-rich plasma in tendon-related disorders: Results and indications. Knee Surg Sports Traumatol Arthrosc. 2018;26(7):1984-99. https://doi.org/10.1007/s00167-016-4261-4 PMid:27665095 DOI: https://doi.org/10.1007/s00167-016-4261-4

Chavda S, Rabbani SA, Wadhwa T. Role and effectiveness of intra-articular injection of hyaluronic acid in the treatment of knee osteoarthritis: A systematic review. Cureus. 2022;14(4):e24503. https://doi.org/10.7759/cureus.24503 PMid:35651409 DOI: https://doi.org/10.7759/cureus.24503

Webb D, Naidoo P. Viscosupplementation for knee osteoarthritis: A focus on hylan G-F 20. Orthop Res Rev. 2018;10:73-81. https://doi.org/10.2147/ORR.S174649 PMid:30774462 DOI: https://doi.org/10.2147/ORR.S174649

Altman R, Hackel J, Niazi F, Shaw P, Nicholls M. Efficacy and safety of repeated courses of hyaluronic acid injections for knee osteoarthritis: A systematic review. Semin Arthritis Rheum. 2018;48(2):168-75. https://doi.org/10.1016/j.semarthrit.2018.01.009 PMid:29496227 DOI: https://doi.org/10.1016/j.semarthrit.2018.01.009

Albanese A, Licata ME, Polizzi B, Campisi G. Platelet-rich plasma (PRP) in dental and oral surgery: From the wound healing to bone regeneration. Immun Ageing. 2013;10(1):23. https://doi.org/10.1186/1742-4933-10-23 PMid:23763951 DOI: https://doi.org/10.1186/1742-4933-10-23

Zhang,Y, Xing F, Luo, R, Duan X. Platelet-rich plasma for bone fracture treatment: A systematic review of current evidence in preclinical and clinical studies. Front Med (Lausanne). 2021;8:676033. https://doi.org/10.3389/fmed.2021.676033 PMid:34414200 DOI: https://doi.org/10.3389/fmed.2021.676033

Qian Y, Han Q, Chen W, Song J, Zhao X, Ouyang Y, et al. Platelet-rich plasma derived growth factors contribute to stem cell differentiation in musculoskeletal regeneration. Front Chem. 2017;5:89. https://doi.org/10.3389/fchem.2017.00089 PMid:29164105 DOI: https://doi.org/10.3389/fchem.2017.00089

Belk JW, Kraeutler MJ, Houck DA, Goodrich JA, Dragoo JL, McCarty EC. Platelet-rich plasma versus hyaluronic acid for knee osteoarthritis: A systematic review and meta- analysis of randomized controlled trials. Am J Sports Med. 2021;49(1):249-60. https://doi.org/10.1177/0363546520909397 PMid:32302218 DOI: https://doi.org/10.1177/0363546520909397

Negrini F, De Lucia F, Negrini S, Tornese D, Facchini F, Vecchio M, et al. Case report: Rehabilitation after platelet-rich growth factors’ intra-articular injections for knee osteoarthritis: Two case reports of a home-based protocol. Front Pharmacol. 2021;12:718060. https://doi.org/10.3389/fphar.2021.718060 PMid:34497519 DOI: https://doi.org/10.3389/fphar.2021.718060

Smith V, Devane D, Begley CM, Clarke M. Methodology in conducting a systematic review of systematic reviews of healthcare interventions. BMC Med Res Methodol. 2011;11(1):15. https://doi.org/10.1186/1471-2288-11-15 PMid:21291558 DOI: https://doi.org/10.1186/1471-2288-11-15

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. https://doi.org/10.1136/bmj.n71 PMid:33782057 DOI: https://doi.org/10.1136/bmj.n71

Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, et al. AMSTAR 2: A critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017;358:j4008. https://doi.org/10.1136/bmj.j4008 DOI: https://doi.org/10.1136/bmj.j4008

Pieper D, Antoine SL, Mathes T, Neugebauer EA, Eikermann M. Systematic review finds overlapping reviews were not mentioned in every other overview. J Clin Epidemiol. 2014;67(4):368-75. https://doi.org/10.1016/j.jclinepi.2013.11.007 PMid:24581293 DOI: https://doi.org/10.1016/j.jclinepi.2013.11.007

Hennessy EA, Johnson BT. Examining overlap of included studies in meta-reviews: Guidance for using the corrected covered area index. Res Synth Methods. 2020;11(1):134-45. https://doi.org/10.1002/jrsm.1390 PMid:31823513 DOI: https://doi.org/10.1002/jrsm.1390

Gong H, Li K, Xie R, Du G, Li L, Wang S, et al. Clinical therapy of platelet-rich plasma vs hyaluronic acid injections in patients with knee osteoarthritis: A systematic review and meta- analysis of randomized double-blind controlled trials. Medicine (Baltimore). 2021;100(12):e25168. https://doi.org/10.1097/MD.0000000000025168 PMid:33761693 DOI: https://doi.org/10.1097/MD.0000000000025168

Li S, Xing F, Yan T, Zhang S, Chen F. Multiple injections of platelet- rich plasma versus hyaluronic acid for knee osteoarthritis: A systematic review and meta-analysis of current evidence in randomized controlled trials. J Pers Med. 2023;13(3):429. https://doi.org/10.3390/jpm13030429 PMid:36983613 DOI: https://doi.org/10.3390/jpm13030429

Hohmann E, Tetsworth K, Glatt V. Is platelet-rich plasma effective for the treatment of knee osteoarthritis? A systematic review and meta-analysis of level 1 and 2 randomized controlled trials. Eur J Orthop Surg Traumatol. 2020;30(6):955-67. https://doi.org/10.1007/s00590-020-02623-4 PMid:32060630 DOI: https://doi.org/10.1007/s00590-020-02623-4

McHugh M. Interrater reliability: The Kappa statistic. Biochem Med (Zagreb). 2012;22(3):276-82. PMid:23092060 DOI: https://doi.org/10.11613/BM.2012.031

Castillo TN, Pouliot MA, Kim HJ, Dragoo JL. Comparison of growth factor and platelet concentration from commercial platelet-rich plasma separation systems. Am J Sports Med. 2011;39(2):266-71. https://doi.org/10.1177/0363546510387517 PMid:21051428 DOI: https://doi.org/10.1177/0363546510387517

Kennedy MI, Whitney K, Evans T, LaPrade RF. Platelet-rich plasma and cartilage repair. Curr Rev Musculoskelet Med. 2018;11(4):573-82. https://doi.org/10.1007/s12178-018-9516-x PMid:30203333 DOI: https://doi.org/10.1007/s12178-018-9516-x

Costa FR, Costa Marques MR, Costa VC, Santos GS, Martins RA, da Silva Santos M, et al. Intra-articular hyaluronic acid in osteoarthritis and tendinopathies: Molecular and clinical approaches. Biomedicines. 2023;11(4):1061. https://doi.org/10.3390/biomedicines11041061 PMid:37189679 DOI: https://doi.org/10.3390/biomedicines11041061

Van Buul GM, Koevoet WL, Kops N, Bos PK, Verhaar JA, Weinans H, et al. Platelet-rich plasma releasate inhibits inflammatory processes in osteoarthritic chondrocytes. Am J Sports Med. 2011;39(11):2362-70. https://doi.org/10.1177/0363546511419278 PMid:21856929 DOI: https://doi.org/10.1177/0363546511419278

Daheshia M, Yao JQ. The interleukin 1beta pathway in the pathogenesis of osteoarthritis. J Rheumatol. 2008;35(12):2306-12. https://doi.org/10.3899/jrheum.080346 PMid:18925684 DOI: https://doi.org/10.3899/jrheum.080346

Boswell SG, Cole BJ, Sundman EA, Karas V, Fortier LA. Platelet-rich plasma: A milieu of bioactive factors. Arthroscopy. 2012;28(3):429-39. https://doi.org/10.1016/j.arthro.2011.10.018 PMid:22284405 DOI: https://doi.org/10.1016/j.arthro.2011.10.018

Leitner GC, Gruber R, Neumüller J, Wagner A, Kloimstein P, Höcker P, et al. Platelet content and growth factor release in platelet-rich plasma: A comparison of four different systems. Vox Sang. 2006;91(2):135-9. https://doi.org/10.1111/j.1423-0410.2006.00815.x PMid:16907874 DOI: https://doi.org/10.1111/j.1423-0410.2006.00815.x