Glinkowski Wojciech Michał, Gut Grzegorz, Śladowski Dariusz
Center of Excellence "TeleOrto" for Telediagnostics and Treatment of Disorders and Injuries of the Locomotor System, Department of Medical Informatics and Telemedicine, Medical University of Warsaw, 02-091 Warsaw, Poland.
Stichting MED PARTNERS, 1052 HK Amsterdam, The Netherlands.
J Clin Med. 2025 Jun 5;14(11):3983. doi: 10.3390/jcm14113983.
Platelet-rich plasma (PRP) is increasingly utilized for managing knee osteoarthritis (KOA), yet its clinical value remains debated due to the variability in preparation protocols and outcome measures.
This narrative review synthesizes current evidence from 40 high-quality studies published between 2013 and March 2025, including randomized controlled trials, systematic reviews, and meta-analyses. The biological mechanisms, clinical effectiveness, safety, and implementation challenges of PRP therapy in KOA are examined.
PRP injections-particularly leukocyte-poor PRP-demonstrate superior pain relief and functional improvement compared to hyaluronic acid and corticosteroids, especially in patients with mild to moderate KOA (Kellgren-Lawrence grades I-III). However, heterogeneity in PRP formulations (platelet/leukocyte content and activation protocols), injection regimens, and follow-up durations limits direct comparability across studies. Evidence from high-quality placebo-controlled trials shows inconsistent long-term benefits, with some failing to demonstrate superiority over saline beyond 6-12 months. The GRADE assessment rates the overall certainty of evidence as moderate. PRP appears safe, with few adverse events reported, but remains costly and variably reimbursed. Guidelines from major societies remain cautious or inconclusive.
PRP is a promising, safe, and well-tolerated option for early to moderate KOA. However, the standardization of preparation protocols, patient selection criteria, and outcome reporting is essential to improve comparability and guide clinical practice.
富血小板血浆（PRP）越来越多地用于治疗膝关节骨关节炎（KOA），但其临床价值因制备方案和结局指标的差异仍存在争议。
本叙述性综述综合了2013年至2025年3月期间发表的40项高质量研究的现有证据，包括随机对照试验、系统评价和荟萃分析。研究了PRP疗法在KOA中的生物学机制、临床有效性、安全性和实施挑战。
与透明质酸和皮质类固醇相比，PRP注射——尤其是低白细胞PRP——在缓解疼痛和改善功能方面表现更优，尤其是在轻度至中度KOA（Kellgren-Lawrence分级I-III级）患者中。然而，PRP制剂（血小板/白细胞含量和激活方案）、注射方案和随访时间的异质性限制了各研究之间的直接可比性。高质量安慰剂对照试验的证据显示长期益处不一致，一些研究未能证明在6-12个月后优于生理盐水。GRADE评估将证据的总体确定性评为中等。PRP似乎是安全的，报告的不良事件很少，但成本高昂且报销情况不一。主要学会的指南仍持谨慎态度或尚无定论。
PRP是早期至中度KOA的一种有前景、安全且耐受性良好的选择。然而，制备方案、患者选择标准和结局报告的标准化对于提高可比性和指导临床实践至关重要。
