Bensa Alessandro, Sangiorgio Alessandro, Boffa Angelo, Salerno Manuela, Moraca Giacomo, Filardo Giuseppe
Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland.
Applied and Translational Research (ATR) Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
EFORT Open Rev. 2024 Sep 2;9(9):883-895. doi: 10.1530/EOR-23-0198.
Intra-articular corticosteroid (CS) injections for knee osteoarthritis (OA) management are endorsed by several scientific societies, while the use of hyaluronic acid (HA) and platelet-rich plasma (PRP) is more controversial. Aim of the study was to quantify and compare the clinical effectiveness of CS injections with respect to HA and PRP in patients with knee OA.
The search was conducted on PubMed, Cochrane, and Web of Science following the PRISMA guidelines. Randomized controlled trials (RCTs) on the comparison of CS injections and HA or PRP injections for the treatment of knee OA were included. The minimal clinically important difference (MCID) was used to interpret the clinical relevance of the improvements at different follow-ups up to 12 months. The study quality was assessed using the Cochrane RoB-2 tool and the GRADE guidelines.
Thirty-five RCTs were included (3348 patients). The meta-analysis comparing CS and HA revealed no difference in terms of WOMAC improvement, while HA showed superior VAS pain improvement at long-term follow-up (P = 0.011), without reaching the MCID. PRP offered a superior WOMAC improvement compared to CS at short- (P = 0.002), mid- (P < 0.001, exceeding the MCID), and long-term (P < 0.001, exceeding the MCID) follow-ups. PRP offered a superior VAS improvement at mid- (P < 0.001, exceeding the MCID) and long-term (P = 0.023) follow-ups.
CS injections for knee OA offer similar results to HA and PRP only at short term, while there is an overall superiority of PRP at longer follow-ups. This difference is not only statistically significant but also clinically relevant in favour of PRP.
关节内注射皮质类固醇（CS）用于膝关节骨关节炎（OA）的治疗得到了多个科学协会的认可，而透明质酸（HA）和富血小板血浆（PRP）的使用则更具争议性。本研究的目的是量化并比较CS注射与HA和PRP在膝关节OA患者中的临床疗效。
按照PRISMA指南在PubMed、Cochrane和科学网进行检索。纳入比较CS注射与HA或PRP注射治疗膝关节OA的随机对照试验（RCT）。使用最小临床重要差异（MCID）来解释长达12个月的不同随访期改善情况的临床相关性。使用Cochrane RoB-2工具和GRADE指南评估研究质量。
纳入35项RCT（3348例患者）。比较CS和HA的荟萃分析显示，在WOMAC改善方面无差异，而HA在长期随访时VAS疼痛改善更优（P = 0.011），但未达到MCID。与CS相比，PRP在短期（P = 0.002）、中期（P < 0.001，超过MCID）和长期（P < 0.001，超过MCID）随访时WOMAC改善更优。PRP在中期（P < 0.001，超过MCID）和长期（P = 0.023）随访时VAS改善更优。
膝关节OA注射CS仅在短期内与HA和PRP效果相似，而在更长的随访期PRP总体上更具优势。这种差异不仅具有统计学意义，而且在临床上有利于PRP。
