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Am Fam Physician. 2014;89(7):578

Clinical Question

Is the injection of platelet-rich plasma beneficial in the management of symptomatic knee osteoarthritis in adults?

Bottom Line

Compared with normal saline or hyaluronic acid, multiple intra-articular injections of platelet-rich plasma significantly improved knee function but did not reduce perceived pain or improve patient satisfaction in adults with symptomatic knee osteoarthritis. (Level of Evidence = 1a–)

Synopsis

These investigators thoroughly searched Medline, Embase, the Cochrane Register, and bibliographies of retrieved citations for studies that evaluated the effectiveness of intra-articular platelet-rich plasma for the treatment of knee osteoarthritis in adults. They included only high-quality randomized controlled trials and cohort studies of patients 18 years or older, with a minimum of 24 weeks of follow-up. No language restrictions were applied. Outcome assessments occurred using previously validated scoring tools for function, pain, and patient satisfaction. Two individuals independently critiqued potential articles for inclusion and methodologic quality. Discrepancies were resolved by consensus discussion with a third reviewer.

Six trials (N = 577 patients) met the inclusion criteria, including four randomized trials and two comparative control groups. Platelet-rich plasma preparation techniques varied among studies, but all six included multiple injections. Five of the studies used hyaluronic acid as the control injection and one used normal saline. After 24 weeks, functional scores improved significantly in the platelet-rich plasma groups compared with the control groups, but there were no significant differences between treatment groups and control groups with respect to pain scores and patient satisfaction. The platelet-rich plasma groups had a significantly higher incidence of adverse events compared with the control groups, although all the complications were nonsevere and self-limited. A formal analysis found minimal heterogeneity in the results among the various trials. No formal evaluation was performed to assess for publication bias.

Study design: Meta-analysis (other)

Funding source: Industry plus government

Setting: Various (meta-analysis)

Reference: KhoshbinALerouxTWassersteinDet alThe efficacy of platelet-rich plasma in the treatment of symptomatic knee osteoarthritis: a systematic review with quantitative synthesis. Arthroscopy.2013; 29( 12): 2037– 2048.

POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

This series is coordinated by Sumi Sexton, MD, editor-in-chief.

A collection of POEMs published in AFP is available at https://www.aafp.org/afp/poems.

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