Patients With Knee Osteoarthritis Who Receive Platelet-Rich Plasma or Bone Marrow Aspirate Concentrate Injections Have Better Outcomes Than Patients Who Receive Hyaluronic Acid: Systematic Review and Meta-analysis

John W Belk; Joseph J Lim; Carson Keeter; Patrick C McCulloch; Darby A Houck; Eric C McCarty; Rachel M Frank; Matthew J Kraeutler

doi:10.1016/j.arthro.2023.03.001

Patients With Knee Osteoarthritis Who Receive Platelet-Rich Plasma or Bone Marrow Aspirate Concentrate Injections Have Better Outcomes Than Patients Who Receive Hyaluronic Acid: Systematic Review and Meta-analysis

Arthroscopy. 2023 Jul;39(7):1714-1734. doi: 10.1016/j.arthro.2023.03.001. Epub 2023 Mar 11.

Authors

John W Belk¹, Joseph J Lim², Carson Keeter³, Patrick C McCulloch⁴, Darby A Houck¹, Eric C McCarty³, Rachel M Frank³, Matthew J Kraeutler⁵

Affiliations

¹ University of Colorado School of Medicine, Aurora, Colorado, U.S.A.
² University of Colorado Boulder, Boulder, Colorado, U.S.A.
³ University of Colorado School of Medicine, Department of Orthopedics, Aurora, Colorado, U.S.A.
⁴ Houston Methodist Hospital, Department of Orthopedics & Sports Medicine, Houston, Texas, U.S.A.
⁵ Houston Methodist Hospital, Department of Orthopedics & Sports Medicine, Houston, Texas, U.S.A.. Electronic address: matthewkraeutlermd@gmail.com.

PMID: 36913992
DOI: 10.1016/j.arthro.2023.03.001

Abstract

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.

Publication types

Meta-Analysis
Systematic Review
Review
Research Support, Non-U.S. Gov't

MeSH terms

Bone Marrow
Humans
Hyaluronic Acid / therapeutic use
Injections, Intra-Articular
Middle Aged
Osteoarthritis, Knee* / drug therapy
Platelet-Rich Plasma*
Treatment Outcome

Substances

Hyaluronic Acid