Platelet-Rich Plasma Is More Effective Than Hyaluronic Acid Injections for Osteoarthritis of the Knee: A Meta-analysis Based on Randomized, Double-Blinded, Controlled Clinical Trials

PURPOSE: To evaluate the difference in clinical efficacy of platelet-rich plasma (PRP) versus hyaluronic acid (HA) in the treatment of knee osteoarthritis (KOA). METHODS: This study conducted a comprehensive search of the Cochrane Library, Web of Science, PubMed, CNKI, Wanfang Data, and VIP databases. Eligible studies underwent rigorous quality assessment using the Cochrane Handbook 8.2 Risk of Bias 2 criteria. A meta-analysis of efficacy-related indicators was performed using RevMan 5.4 software. RESULTS: Fifteen double-blind randomized controlled trials comprising 1,632 patients with KOA ranging from I to III on the Kellgren-Lawrence grading scale were included. Meta-analysis revealed that the PRP group exhibited significantly lower Western Ontario and McMaster Universities Osteoarthritis Index pain scores and total scores from baseline compared to the HA group at 12 months (MD = -1.14; 95% CI, -2.09 to -0.20; P = .02; MD = -7.33; 95% CI, -12.81 to -1.85; P = .009, respectively), both of which reached the minimal clinically important difference. Visual analog scale scores were also significantly reduced in the PRP group at 12 months (mean difference [MD] = -0.35; 95% CI, -0.59 to -0.10; P = .005, respectively). Improved International Knee Documentation Committee scores were observed in the PRP group at 1 month (MD = 3.13; 95% CI, 1.34-4.93; P = .0006, respectively). CONCLUSIONS: After 12 months, there were statistically significant differences in Western Ontario and McMaster Universities Osteoarthritis Index pain and total scores, as well as minimal clinically important differences, with PRP being superior to HA in the treatment of KOA. LEVEL OF EVIDENCE: Level Ⅱ, meta-analysis of Level Ⅰ and Ⅱ studies.