NYU Langone Orthopedic Hospital, Division of Sports Medicine, 333 E 38th Street, New York, NY 10016, United States.
NYU Langone Orthopedic Hospital, Division of Sports Medicine, 333 E 38th Street, New York, NY 10016, United States.
Knee. 2021 Oct;32:173-182. doi: 10.1016/j.knee.2021.08.008. Epub 2021 Sep 6.
Osteoarthritis (OA) is a debilitating joint disease characterized by progressive loss of articular cartilage. Intra-articular injections are a mainstay of nonoperative treatment, however, there is controversy as to the optimal injectable for these patients. The purpose of the current study is to perform a network meta-analysis of the randomized control trials in the literature to ascertain whether there is a superior injectable nonoperative treatment for knee OA.
The literature search was conducted based on the PRISMA guidelines. Randomized control trials (RCTs) evaluating intra-articular injectables in osteoarthritic knees were included. Data was extracted and Visual Analogue Scale (VAS) scores and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, where available were analyzed at 1, 3, 6 and 12 months. Clinical outcomes were compared using a frequentist approach to network meta-analysis, with statistical analysis performed using R. The treatment options were ranked using the P-Score.
Seventy-nine RCTs with 8761 patients were included in this review. Intra-articular injectables evaluated included autologous conditioned serum (ACS), bone marrow aspirate concentrate (BMAC), botulinum toxin, corticosteroids (CS), hyaluronic acid (HA), mesenchymal stem cells (MSC), ozone, saline placebo, platelet-rich plasma (PRP), plasma rich in growth factor (PRGF), and stromal vascular fraction (SVF). At 4-6 weeks and 3 months of follow-up, the treatment with the highest P-Score for WOMAC score was high molecular weight (HMW) HA + CS [P-Score = 0.9500 and 8503, respectively]. At 6-months follow-up, the treatment with the highest P-Score for WOMAC score was PRP [P-Score = 0.7676]. At all post-injection time points, the treatment with the highest P-Score for VAS score [P-Score Range = 0.8631-9927] and Womac score at 12 Months [P-Score = 0.9044] was SVF.
The current evidence shows that SVF injections result in the greatest improvement in pain and functional outcomes in patients with knee OA at up to 1 year of follow-up.
骨关节炎（OA）是一种进行性关节软骨丧失为特征的致残性关节疾病。关节内注射是非手术治疗的主要方法，然而，对于这些患者，最佳的注射方法仍存在争议。本研究的目的是对文献中的随机对照试验进行网络荟萃分析，以确定是否存在治疗膝骨关节炎的更优的非手术关节内注射方法。
根据 PRISMA 指南进行文献检索。纳入评估关节内注射治疗膝骨关节炎的随机对照试验。提取数据，分析视觉模拟量表（VAS）评分和西部安大略省和麦克马斯特大学骨关节炎指数（WOMAC）评分，如有则在 1、3、6 和 12 个月时进行分析。使用基于似然的网络荟萃分析方法对临床结果进行比较，使用 R 进行统计分析。使用 P 评分对治疗方案进行排名。
本综述共纳入 79 项 RCT 和 8761 例患者。评估的关节内注射包括自体条件血清（ACS）、骨髓抽吸浓缩物（BMAC）、肉毒杆菌毒素、皮质类固醇（CS）、透明质酸（HA）、间充质干细胞（MSC）、臭氧、生理盐水安慰剂、富血小板血浆（PRP）、富含生长因子的 PRP（PRGF）和基质血管成分（SVF）。在 4-6 周和 3 个月的随访中，WOMAC 评分最高的 P 评分治疗药物是高分子量（HMW）HA+CS[P 评分分别为 0.9500 和 0.8503]。在 6 个月的随访中，WOMAC 评分最高的 P 评分治疗药物是 PRP[P 评分 0.7676]。在所有注射后时间点，VAS 评分和 WOMAC 评分最高的 P 评分治疗药物（P 评分范围为 0.8631-9927）和 12 个月时 WOMAC 评分（P 评分 0.9044）均为 SVF。
目前的证据表明，SVF 注射可在 1 年的随访中最大程度地改善膝骨关节炎患者的疼痛和功能结局。
