Abstract
Objectives
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
PubMed/MEDLINE, Scopus, and Cochrane databases were queried for level I to II randomized clinical trials with a minimum follow-up of 6 months that investigated the treatments of interest. Patient reported outcome scores for pain and function at baseline and at latest follow-up were extracted and the change in scores were converted to uniform 0-100 scales. An arm-based Bayesian network meta-analysis in a random-effects model was created to compare the treatment arms in terms of pain and function. Cumulative ranking of injection types based on pain and function effect differences was calculated using the SUCRA of interventions values.
Results
Forty-seven studies were included, most of which with overall low risk of bias (72.3%). HA and PRP both led to a significant improvement in pain compared to placebo. HA, PRP, and BMAC all led to a significant improvement in function scores when compared to placebo. Surface under the cumulative ranking curves (SUCRA) of the interventions revealed PRP, BMAC, and HA overall SUCRA scores of 91.61, 76.46, and 53.06 respectively. For the treatment of pain in patients with knee osteoarthritis, PRP ranked as the best intra-articular injection, followed by BMAC, then HA, then CS. For function improvement, PRP similarly ranked as the best injection, followed by BMAC, then HA.
Conclusion
Intra-articular PRP, BMAC and HA are all beneficious relative to placebo at 6 months for knee osteoarthritis. The results of the current study suggest PRP was the most efficacious intra-articular injection in terms of pain and function.