IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
Ospedale Regionale di Lugano, Lugano, Switzerland.
Cartilage. 2021 Dec;13(1_suppl):364S-375S. doi: 10.1177/1947603520931170. Epub 2020 Jun 19.
To evaluate effectiveness, in terms of patient-reported outcome measures, of platelet-rich plasma (PRP) injections for knee osteoarthritis compared to placebo and other intraarticular treatments.
PubMed, Cochrane Library, Scopus, Embase, Web of Science, as well as the gray literature were searched on January 17, 2020. Randomized controlled trials (RCTs) comparing PRP injections with placebo or other injectable treatments, in any language, on humans, were included. Risk of bias was assessed following the Cochrane guidelines; quality of evidence was graded using the GRADE guidelines.
Thirty-four RCTs, including 1403 knees in PRP groups and 1426 in control groups, were selected. WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) score favored PRP, with a statistically and clinically significant difference versus placebo at 12-month follow-up ( = 0.02) and versus HA (hyaluronic acid) at 6-month ( < 0.001) and 12-month ( < 0.001) follow-ups. A clinically significant difference favoring PRP versus steroids was documented for VAS (Visual Analogue Scale) pain ( < 0.001), KOOS (Knee Injury and Osteoarthritis Outcome Score) pain ( < 0.001), function in daily activities ( = 0.001), and quality of life ( < 0.001) at 6-month follow-up. However, superiority of PRP did not reach the minimal clinically important difference for all outcomes, and quality of evidence was low.
The effect of platelet concentrates goes beyond its mere placebo effect, and PRP injections provide better results than other injectable options. This benefit increases over time, being not significant at earlier follow-ups but becoming clinically significant after 6 to 12 months. However, although substantial, the improvement remains partial and supported by low level of evidence. This finding urges further research to confirm benefits and identify the best formulation and indications for PRP injections in knee OA.
通过患者报告的结局测量，评估富血小板血浆（PRP）注射治疗膝骨关节炎的效果，与安慰剂和其他关节内治疗相比。
于 2020 年 1 月 17 日检索了 PubMed、Cochrane 图书馆、Scopus、Embase、Web of Science 以及灰色文献。纳入了比较 PRP 注射与安慰剂或其他注射治疗的随机对照试验（RCT），语言不限，人群为人类。使用 Cochrane 指南评估偏倚风险；使用 GRADE 指南对证据质量进行分级。
共纳入 34 项 RCT，PRP 组包括 1403 个膝关节，对照组包括 1426 个膝关节。WOMAC（西安大略和麦克马斯特大学骨关节炎指数）评分有利于 PRP，与安慰剂相比，12 个月随访时具有统计学和临床意义差异（ = 0.02），与 HA（透明质酸）相比，6 个月（<0.001）和 12 个月（<0.001）随访时具有统计学和临床意义差异。与皮质类固醇相比，PRP 对 VAS（视觉模拟量表）疼痛（<0.001）、KOOS（膝关节损伤和骨关节炎结果评分）疼痛（<0.001）、日常活动功能（ = 0.001）和生活质量（<0.001）的临床意义差异有利，6 个月随访时差异具有统计学意义。然而，PRP 的优势并未达到所有结局的最小临床重要差异，证据质量较低。
血小板浓缩物的效果超出了单纯的安慰剂效应，PRP 注射提供的效果优于其他注射选择。这种益处随着时间的推移而增加，在早期随访时并不显著，但在 6 至 12 个月后具有临床意义。然而，尽管改善程度较大，但仍然是部分的，且证据水平较低。这一发现促使进一步研究以确认 PRP 注射治疗膝骨关节炎的益处，并确定最佳配方和适应证。
