Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.; Instituto Brasil de Tecnologia de Saude, Rio de Janeiro, Brazil; Department of Orthopedics and Traumatology, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil.
Arthroscopy. 2024 May;40(5):1623-1636.e1. doi: 10.1016/j.arthro.2024.01.037. Epub 2024 Feb 7.
PURPOSE: To compare the efficacy of common intra-articular injections used in the treatment of knee osteoarthritis, including corticosteroid (CS), hyaluronic acid (HA), platelet-rich plasma (PRP), and bone marrow aspirate concentrate (BMAC), with a minimum follow-up of 6-months. METHODS: A literature search was conducted using the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in August 2022 in the following databases: PubMed/MEDLINE, Scopus, Cochrane Database of Controlled Trials, and the Cochrane Database of Systematic Reviews. Level I to II randomized clinical trials with a minimum follow-up of 6 months that investigated the treatments of interest were included. Patient-reported outcome scores for pain and function at baseline and at latest follow-up were extracted, and the change in scores was converted to uniform 0 to 100 scales. Arm-based Bayesian network meta-analysis using a random-effects model was created to compare the treatment arms in pain and function. RESULTS: Forty-eight studies comprising a total of 9,338 knees were included. The most studied intra-articular injection was HA (40.9%), followed by placebo (26.2%), PRP (21.5%), CS (8.8%), and then BMAC (2.5%). HA and PRP both led to a significant improvement in pain compared with placebo. HA, PRP, and BMAC all led to a significant improvement in function scores when compared with placebo. Surface under the cumulative ranking curves (SUCRAs) of the interventions revealed that PRP, BMAC, and HA were the treatments with the highest likelihood of improvement in both pain and function, with overall SUCRA scores of 91.54, 76.46, and 53.12, respectively. The overall SUCRA scores for CS and placebo were 15.18 and 13.70, respectively. CONCLUSIONS: At a minimum 6-month follow-up, PRP demonstrated significantly improved pain and function for patients with knee osteoarthritis compared with placebo. Additionally, PRP exhibited the highest SUCRA values for these outcomes when compared with BMAC, HA, and CS. LEVEL OF EVIDENCE: Level II, meta-analysis of Level I to II studies.
目的：比较常用于治疗膝骨关节炎的关节内注射的疗效，包括皮质类固醇（CS）、透明质酸（HA）、富血小板血浆（PRP）和骨髓抽吸浓缩物（BMAC），随访时间至少为 6 个月。
方法：根据 2020 年系统评价和荟萃分析报告的首选条目指南，于 2022 年 8 月在以下数据库中进行文献检索：PubMed/MEDLINE、Scopus、Cochrane 对照试验数据库和 Cochrane 系统评价数据库。纳入了随访时间至少为 6 个月、研究治疗方法的 I 级和 II 级随机临床试验。提取基线和最新随访时的疼痛和功能的患者报告结局评分，并将评分的变化转换为统一的 0 至 100 评分。使用随机效应模型的基于手臂的贝叶斯网络荟萃分析创建了用于比较疼痛和功能的治疗臂。
结果：共纳入 48 项研究，总计 9338 个膝关节。最常见的关节内注射是 HA（40.9%），其次是安慰剂（26.2%）、PRP（21.5%）、CS（8.8%）和 BMAC（2.5%）。HA 和 PRP 均与安慰剂相比显著改善了疼痛。与安慰剂相比，HA、PRP 和 BMAC 均显著改善了功能评分。干预措施的累积排序曲线下面积（SUCRA）显示，PRP、BMAC 和 HA 是改善疼痛和功能的可能性最大的治疗方法，总体 SUCRA 评分分别为 91.54、76.46 和 53.12。CS 和安慰剂的总体 SUCRA 评分分别为 15.18 和 13.70。
结论：至少在 6 个月的随访中，PRP 与安慰剂相比，显著改善了膝骨关节炎患者的疼痛和功能。此外，与 BMAC、HA 和 CS 相比，PRP 在这些结果方面表现出最高的 SUCRA 值。
证据等级：II 级，I 级和 II 级研究的荟萃分析。
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