Betzler Brjan Kaiji, Chee Yan-Yu Julius, Bin Abd Razak Hamid Rahmatullah
Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
Department of Orthopaedic Surgery, Sengkang General Hospital, Singapore.
Arthrosc Sports Med Rehabil. 2021 Jul 29;3(5):e1557-e1567. doi: 10.1016/j.asmr.2021.06.006. eCollection 2021 Oct.
To evaluate clinical outcomes after intraosseous injection for knee osteoarthritis systematically with available clinical evidence.
A systematic search methodology of the PUBMED, EMBASE, and CINAHL databases was conducted in November 2020. The search workflow was in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The following inclusion criteria were adopted: clinical trials of any level of evidence, reporting clinical outcomes following intraosseous injections of bone substitutes or biologic agents, and mesenchymal stem cells or platelet-rich plasma into the knee as treatment modalities for osteoarthritis. Duplicate data and articles not written in English were excluded from this review.
Six studies were identified and included in this review, with a total of 167 patients. Two studies used subchondroplasty CaP injections, while 4 studies used intraosseous injections of platelet-rich plasma. Two studies provided Level II evidence, 2 studies provided Level III evidence, and a further 2 provided Level IV evidence. Five out of 6 studies reported data using the visual analog scale, 4 studies used the Knee Injury and Osteoarthritis Outcome Score, while 3 studies used the Western Ontario and McMaster Universities Osteoarthritis Index. Clinical improvements in pain and functionality were documented in all trials, with only a few patients experiencing adverse events.
Intraosseous injections for knee osteoarthritis are safe and effective. However, multiple pertinent variables such as safety, cost of treatment, and performance against placebos and other treatment modalities require further evaluation before intraosseous injections can be considered as standard treatment for patients presenting with osteoarthritis of the knee.
利用现有临床证据系统评价膝关节骨关节炎骨内注射后的临床疗效。
2020年11月对PUBMED、EMBASE和CINAHL数据库进行了系统检索。检索流程遵循系统评价和Meta分析的首选报告项目（PRISMA）。采用以下纳入标准：任何证据水平的临床试验，报告骨内注射骨替代物或生物制剂、间充质干细胞或富血小板血浆治疗膝关节骨关节炎后的临床疗效。本综述排除重复数据和非英文撰写的文章。
本综述共纳入6项研究，涉及167例患者。2项研究使用软骨下成形术注射磷酸钙，4项研究使用骨内注射富血小板血浆。2项研究提供了II级证据，2项研究提供了III级证据，另外2项提供了IV级证据。6项研究中有5项使用视觉模拟量表报告数据，4项研究使用膝关节损伤和骨关节炎疗效评分，3项研究使用西安大略和麦克马斯特大学骨关节炎指数。所有试验均记录了疼痛和功能的临床改善情况，只有少数患者出现不良事件。
膝关节骨关节炎的骨内注射安全有效。然而，在将骨内注射视为膝关节骨关节炎患者的标准治疗方法之前，需要进一步评估多个相关变量，如安全性、治疗成本以及与安慰剂和其他治疗方式相比的疗效。
