, Ballymena, UK.
School of Medicine, Dentistry and Biomedical Science, Queens University Belfast, Belfast, United Kingdom.
BMC Musculoskelet Disord. 2021 Jun 16;22(1):550. doi: 10.1186/s12891-021-04308-3.
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.
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.
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).
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.
CRD42020181928 .
关节内（IA）皮质类固醇（CS）注射是治疗膝关节骨关节炎（OA）症状的主要方法，尤其是在英国。关节内富含血小板的血浆（PRP）注射是一种有前途的替代方法，但迄今为止尚无系统评价将其与 IA CS 注射的当前标准治疗进行比较。我们旨在研究 IA PRP 注射与 IA CS 注射治疗膝关节 OA 的症状管理效果。
纳入了比较 IA PRP 和 CS 注射治疗膝关节 OA 的所有已发表试验。通过 2020 年 6 月的 MEDLINE、EMBASE、Scopus 和 Web of Science 进行了检索。使用 Cochrane 偏倚风险工具评估了偏倚风险。使用随机效应模型计算 WOMAC/VAS 评分（或子评分）中 IA PRP 与 CS 注射之间的标准化均数差，置信区间为 95%。
纳入了 8 项研究和 648 名患者，其中 443 名（68%）为女性，平均年龄 59 岁，平均 BMI 为 28.4。总体而言，这些研究被认为具有低偏倚风险。与 CS 注射相比，PRP 在 3、6 和 9 个月时明显更好地减轻 OA 症状（疼痛、僵硬、功能）（P<0.01）。在 6 和 9 个月时观察到最大效果（-0.78（-1.34 至 -0.23）标准均数差和-1.63（-2.14 至-1.12）标准均数差）。在 6 个月时，这相当于 WOMAC 评分降低 9.51 分或 VAS 疼痛评分降低 0.97 分。在 6 个月时，PRP 允许比 CS 更多地恢复体育活动，通过 KOOS 体育活动亚量表衡量，程度为 9.7（-0.45 至 19.85）（P=0.06）。在 12 个月的随访中，三次 PRP 注射（通常相隔一周）优于单次注射（P<0.01）。
与 CS 注射相比，IA-PRP 注射在膝关节 OA 的症状管理方面产生了更好的结果，包括改善疼痛管理、减少关节僵硬和更好地参与运动/体育活动，在 12 个月的随访中。与单次 IA-PRP 注射相比，每周进行三次 IA-PRP 注射（相隔一周）似乎更有效。
PROSPERO 临床试验注册号：CRD42020181928。
