Intra-articular platelet-rich plasma versus hyaluronic acid in the treatment of knee osteoarthritis: a meta-analysis

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Abstract
Purpose: Platelet-rich plasma (PRP) and hyaluronic acid (HA) have been increasingly used in recent years to treat knee osteoarthritis (OA). However, whether PRP is superior to HA is controversial. Methods: We conducted an electronic search of PubMed, Embase, ScienceDirect, and Cochrane library. The pooled data were analyzed using RevMan 5.1. Results: Three prospective and ten randomized trials were identified. PRP injections reduced pain more effectively than HA injections in OA of the knee at 6 months (mean difference [MD]=-14.18; 95% confidence interval [CI]: -26.12 to -2.23; P=0.02; I2=95%) and 12 months (MD=-15.25; 95% CI: -22.17 to -8.32; PI2=81%) of follow-up evaluated by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score, while the VAS showed no significant difference at 3 months (MD=-0.98; 95% CI: -2.55 to 0.59; P=0.22; I2=90%) and 6 months (MD=-0.82; 95% CI: -1.80 to 0.16; P=0.1; I2=83%). Additionally, similar results were observed for the function recovery according to the WOMAC function score and EuroQol-visual analog scales. Conclusion: The intra-articular injection of PRP was not obviously superior to HA in knee OA. Due to the limited quality and data of the evidence currently available, more high-quality randomized controlled trials are required.

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