Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA.
Department of Orthopaedic Surgery, St Joseph's University Medical Center, Paterson, New Jersey, USA.
Am J Sports Med. 2021 Jan;49(1):249-260. doi: 10.1177/0363546520909397. Epub 2020 Apr 17.
Platelet-rich plasma (PRP) and hyaluronic acid (HA) are 2 nonoperative treatment options for knee osteoarthritis (OA) that are supposed to provide symptomatic relief and help delay surgical intervention.
To systematically review the literature to compare the efficacy and safety of PRP and HA injections for the treatment of knee OA.
Meta-analysis of level 1 studies.
A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to identify level 1 studies that compared the clinical efficacy of PRP and HA injections for knee OA. The search phrase used was . Patients were assessed via the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analog scale (VAS) for pain, and Subjective International Knee Documentation Committee (IKDC) scale. A subanalysis was also performed to isolate results from patients who received leukocyte-poor and leukocyte-rich PRP.
A total of 18 studies (all level 1) met inclusion criteria, including 811 patients undergoing intra-articular injection with PRP (mean age, 57.6 years) and 797 patients with HA (mean age, 59.3 years). The mean follow-up was 11.1 months for both groups. Mean improvement was significantly higher in the PRP group (44.7%) than the HA group (12.6%) for WOMAC total scores ( < .01). Of 11 studies based on the VAS, 6 reported PRP patients to have significantly less pain at latest follow-up when compared with HA patients ( < .05). Of 6 studies based on the Subjective IKDC outcome score, 3 reported PRP patients to have significantly better scores at latest follow-up when compared with HA patients ( < .05). Finally, leukocyte-poor PRP was associated with significantly better Subjective IKDC scores versus leukocyte-rich PRP ( < .05).
Patients undergoing treatment for knee OA with PRP can be expected to experience improved clinical outcomes when compared with HA. Additionally, leukocyte-poor PRP may be a superior line of treatment for knee OA over leukocyte-rich PRP, although further studies are needed that directly compare leukocyte content in PRP injections for treatment of knee OA.
富血小板血浆（PRP）和透明质酸（HA）是两种非手术治疗膝骨关节炎（OA）的方法，旨在提供症状缓解并有助于延迟手术干预。
系统地回顾文献，比较 PRP 和 HA 注射治疗膝 OA 的疗效和安全性。
1 级研究的荟萃分析。
通过搜索 PubMed、Cochrane 图书馆和 Embase 来进行系统评价，以确定比较 PRP 和 HA 注射治疗膝 OA 的临床疗效的 1 级研究。使用的搜索词是. 患者通过 Western Ontario 和 McMaster 大学骨关节炎指数（WOMAC）、疼痛视觉模拟量表（VAS）和主观国际膝关节文献委员会（IKDC）量表进行评估。还进行了亚分析，以分离接受白细胞减少和白细胞丰富的 PRP 的患者的结果。
共有 18 项研究（均为 1 级）符合纳入标准，包括 811 例接受关节内注射 PRP（平均年龄 57.6 岁）和 797 例接受 HA（平均年龄 59.3 岁）的患者。两组的平均随访时间均为 11.1 个月。PRP 组的 WOMAC 总分平均改善率（44.7%）明显高于 HA 组（12.6%）（<.01）。在基于 VAS 的 11 项研究中，有 6 项报告 PRP 患者在最新随访时疼痛明显减轻，与 HA 患者相比（<.05）。在基于主观 IKDC 结果评分的 6 项研究中，有 3 项报告 PRP 患者在最新随访时评分明显优于 HA 患者（<.05）。最后，白细胞减少的 PRP 与白细胞丰富的 PRP 相比，主观 IKDC 评分明显更好（<.05）。
与 HA 相比，接受 PRP 治疗膝 OA 的患者的临床结局有望得到改善。此外，白细胞减少的 PRP 可能是治疗膝 OA 的一种优于白细胞丰富的 PRP 的治疗方法，尽管需要进一步的研究来直接比较 PRP 注射治疗膝 OA 的白细胞含量。
