Michael McLarnon1,2, Neil Heron3,4,5,6. 1. , Ballymena, UK. mmclarnon15@qub.ac.uk. 2. School of Medicine, Dentistry and Biomedical Science, Queens University Belfast, Belfast, United Kingdom. mmclarnon15@qub.ac.uk. 3. School of Medicine, Dentistry and Biomedical Science, Queens University Belfast, Belfast, United Kingdom. 4. Centre for Public Health Research, Queen's University, Belfast, UK. 5. UKCRC Centre of Excellence for Public Health Research (Northern Ireland), Belfast, United Kingdom. 6. Department of General Practice, Keele University, Newcastle, England.
Abstract
BACKGROUND: Intra-articular (IA) corticosteroid (CS) injections are the mainstay of treatment for symptomatic management in knee osteoarthritis (OA), particularly in the UK. IA platelet-rich plasma (PRP) injections are a promising alternative, but no systematic reviews to date have compared them to the current standard of care, IA CS injections. We aim to investigate the effect of IA PRP injections versus IA corticosteroid injections for the symptomatic management of knee OA. METHODS: All published trials comparing IA PRP and CS injections for knee OA were included. MEDLINE, EMBASE, Scopus and Web of Science were searched through June 2020. Risk of bias was assessed using the Cochrane Risk of Bias tool. A random effects model was used to calculate standardized mean difference with 95% confidence interval in WOMAC/VAS score (or subscores), comparing IA PRP to CS injections across studies. RESULTS: Included were eight studies and 648 patients, 443 (68%) were female, mean age 59 years, with a mean BMI of 28.4. Overall, the studies were considered at low risk of bias. Compared with CS injections, PRP was significantly better in reducing OA symptoms (pain, stiffness, functionality) at 3, 6 and 9 months post-intervention (P < 0.01). The greatest effect was observed at 6 and 9 months (- 0.78 (- 1.34 to - 0.23) standard mean deviations (SMD) and - 1.63 (- 2.14 to - 1.12) SMD respectively). At 6 months, this equates to an additional reduction of 9.51 in WOMAC or 0.97 on the VAS pain scales. At 6 months PRP allowed greater return to sporting activities than CS, measured by the KOOS subscale for sporting activity, of magnitude 9.7 (- 0.45 to 19.85) (P = 0.06). Triple injections of PRP, generally separated by a week, were superior to single injections over 12 months follow-up (P < 0.01). CONCLUSIONS: IA-PRP injections produce superior outcomes when compared with CS injections for symptomatic management of knee OA, including improved pain management, less joint stiffness and better participation in exercise/sporting activity at 12 months follow-up. Giving three IA-PRP, with injections separated by a week, appears more effective than 1 IA-PRP injection. PROSPERO TRIAL REGISTRATION NUMBER: CRD42020181928 .
BACKGROUND: Intra-articular (IA) corticosteroid (CS) injections are the mainstay of treatment for symptomatic management in knee osteoarthritis (OA), particularly in the UK. IA platelet-rich plasma (PRP) injections are a promising alternative, but no systematic reviews to date have compared them to the current standard of care, IA CS injections. We aim to investigate the effect of IA PRP injections versus IA corticosteroid injections for the symptomatic management of knee OA. METHODS: All published trials comparing IA PRP and CS injections for knee OA were included. MEDLINE, EMBASE, Scopus and Web of Science were searched through June 2020. Risk of bias was assessed using the Cochrane Risk of Bias tool. A random effects model was used to calculate standardized mean difference with 95% confidence interval in WOMAC/VAS score (or subscores), comparing IA PRP to CS injections across studies. RESULTS: Included were eight studies and 648 patients, 443 (68%) were female, mean age 59 years, with a mean BMI of 28.4. Overall, the studies were considered at low risk of bias. Compared with CS injections, PRP was significantly better in reducing OA symptoms (pain, stiffness, functionality) at 3, 6 and 9 months post-intervention (P < 0.01). The greatest effect was observed at 6 and 9 months (- 0.78 (- 1.34 to - 0.23) standard mean deviations (SMD) and - 1.63 (- 2.14 to - 1.12) SMD respectively). At 6 months, this equates to an additional reduction of 9.51 in WOMAC or 0.97 on the VAS pain scales. At 6 months PRP allowed greater return to sporting activities than CS, measured by the KOOS subscale for sporting activity, of magnitude 9.7 (- 0.45 to 19.85) (P = 0.06). Triple injections of PRP, generally separated by a week, were superior to single injections over 12 months follow-up (P < 0.01). CONCLUSIONS:IA-PRP injections produce superior outcomes when compared with CS injections for symptomatic management of knee OA, including improved pain management, less joint stiffness and better participation in exercise/sporting activity at 12 months follow-up. Giving three IA-PRP, with injections separated by a week, appears more effective than 1 IA-PRP injection. PROSPERO TRIAL REGISTRATION NUMBER: CRD42020181928 .
Authors: Marita Cross; Emma Smith; Damian Hoy; Sandra Nolte; Ilana Ackerman; Marlene Fransen; Lisa Bridgett; Sean Williams; Francis Guillemin; Catherine L Hill; Laura L Laslett; Graeme Jones; Flavia Cicuttini; Richard Osborne; Theo Vos; Rachelle Buchbinder; Anthony Woolf; Lyn March Journal: Ann Rheum Dis Date: 2014-02-19 Impact factor: 19.103
Authors: Carlos J Meheux; Patrick C McCulloch; David M Lintner; Kevin E Varner; Joshua D Harris Journal: Arthroscopy Date: 2015-10-01 Impact factor: 4.772
Authors: Jason L Dragoo; Christina M Danial; Hillary J Braun; Michael A Pouliot; Hyeon Joo Kim Journal: Knee Surg Sports Traumatol Arthrosc Date: 2011-12-21 Impact factor: 4.342
Authors: Emily A Sundman; Brian J Cole; Vasili Karas; Craig Della Valle; Mathew W Tetreault; Hussni O Mohammed; Lisa A Fortier Journal: Am J Sports Med Date: 2013-11-05 Impact factor: 6.202
Authors: D T Felson; R C Lawrence; P A Dieppe; R Hirsch; C G Helmick; J M Jordan; R S Kington; N E Lane; M C Nevitt; Y Zhang; M Sowers; T McAlindon; T D Spector; A R Poole; S Z Yanovski; G Ateshian; L Sharma; J A Buckwalter; K D Brandt; J F Fries Journal: Ann Intern Med Date: 2000-10-17 Impact factor: 25.391
Authors: Kelvin P Jordan; Umesh T Kadam; Richard Hayward; Mark Porcheret; Catherine Young; Peter Croft Journal: BMC Musculoskelet Disord Date: 2010-07-02 Impact factor: 2.362
Authors: Timothy E McAlindon; Michael P LaValley; William F Harvey; Lori Lyn Price; Jeffrey B Driban; Ming Zhang; Robert J Ward Journal: JAMA Date: 2017-05-16 Impact factor: 56.272