Yu Dongsheng, Zhao Jiani, Zhao Kun
Center for Rehabilitation Medicine, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China.
School of Public Health, Hangzhou Medical College, Hangzhou, China.
J Orthop Surg Res. 2025 Jun 24;20(1):614. doi: 10.1186/s13018-025-06026-1.
PURPOSE: Osteoarthritis (OA) is a widespread joint disease characterized by the gradual loss of cartilage. Intra-articular injections, including platelet-rich plasma (PRP), are commonly used for treatment, but the optimal PRP preparation method remains debated. This study aims to perform a network meta-analysis of randomized controlled trials to compare the efficacy of different PRP preparation methods and determine the most effective protocols. METHODS: The literature search was conducted based on PRISMA guidelines. Randomized controlled trials (RCTs) evaluating intra-articular injectables in osteoarthritic knees were included. Data were extracted, and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were analyzed at 3, 6, and 12-18 months. Clinical outcomes were compared using a frequentist network meta-analysis, and treatment options were ranked using the P-Score. Statistical analysis was performed using R 4.3.2. RESULTS: Twenty-three RCTs with 1752 patients were included. Treatments included PRP, plasma rich in growth factor (PRGF), leukocyte-poor PRP (LP-PRP), leukocyte-rich PRP (LR-PRP), hyaluronic acid (HA), and saline placebo. Leukocyte-rich PRP with low platelet concentration increase, using both anticoagulant and activator showed the best effects on WOMAC pain and stiffness scores within 6 months (WMD = 26.02; 95% CrI, 0.92-52.46). Leukocyte-poor PRP with high platelet concentration increase, using anticoagulant without activator was most effective for WOMAC function and stiffness at 12-18 months (WMD = 18.94; 95% CrI, 8.34-28.12). Long-term results indicated Leukocyte-poor PRP with low platelet concentration increase, using anticoagulant without activator yielded the best outcomes for cartilage repair and function (WMD = 17.09; 95% CrI, -8.4 to 42.78). CONCLUSIONS: Optimizing OA treatment involves tailoring PRP protocols to disease stage, with low platelet, high leukocyte PRP (RPRP_LPC_Y_Y) recommended for early OA due to its anti-inflammatory effects and high platelet, low leukocyte PRP (PPRP-HPC) preferred for advanced OA to promote tissue repair and regeneration.
目的：骨关节炎（OA）是一种常见的关节疾病，其特征是软骨逐渐丧失。包括富血小板血浆（PRP）在内的关节内注射常用于治疗，但最佳的PRP制备方法仍存在争议。本研究旨在对随机对照试验进行网状Meta分析，以比较不同PRP制备方法的疗效，并确定最有效的方案。 方法：根据PRISMA指南进行文献检索。纳入评估骨关节炎膝关节关节内注射剂的随机对照试验（RCT）。提取数据，并在3、6和12 - 18个月时分析西安大略和麦克马斯特大学骨关节炎指数（WOMAC）评分。使用频率学派网状Meta分析比较临床结局，并使用P值对治疗方案进行排序。使用R 4.3.2进行统计分析。 结果：纳入了23项RCT，共1752例患者。治疗方法包括PRP、富含生长因子的血浆（PRGF）、低白细胞PRP（LP - PRP）、高白细胞PRP（LR - PRP）、透明质酸（HA）和生理盐水安慰剂。血小板浓度增加低的高白细胞PRP，同时使用抗凝剂和激活剂，在6个月内对WOMAC疼痛和僵硬评分显示出最佳效果（加权均数差[WMD]=26.02；95%可信区间[CrI]，0.92 - 52.46）。血小板浓度增加高的低白细胞PRP，使用抗凝剂但不使用激活剂，在12 - 18个月时对WOMAC功能和僵硬最有效（WMD = 18.94；95% CrI，8.34 - 28.12）。长期结果表明，血小板浓度增加低的低白细胞PRP，使用抗凝剂但不使用激活剂，在软骨修复和功能方面产生最佳结果（WMD = 17.09；95% CrI，-8.4至42.78）。 结论：优化OA治疗需要根据疾病阶段调整PRP方案，由于其抗炎作用，低血小板、高白细胞PRP（RPRP_LPC_Y_Y）推荐用于早期OA，而高血小板、低白细胞PRP（PPRP - HPC）则更适合晚期OA以促进组织修复和再生。
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