[Efficacy of Intra-Articular Platelet-Rich Plasma in Knee Osteoarthritis: a Systematic Review and Meta-Analysis]

The treatment of knee osteoarthritis (KOA) must be comprehensive and personalised. Administration of platelet-rich plasma (PRP) is one of the interventions that has been investigated for a long time. Professional medical societies have so far failed to adopt a clear and consistent stance on this therapy, despite a number of randomized clinical trials (RCTs) conducted in the past. The aim of our review was to evaluate the results of RCTs published over the last 5 years. We do believe that a meta-analysis based on the best of the available studies will help articulate the national position on this treatment modality.

Our review covers all RCTs evaluating the effect of PRP on KOA that were published between 2020 and 2024. PubMed, OVID and Scopus databases were searched for the relevant data. The effect of PRP administration was evaluated using the total WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index), VAS (Visual Analogue Scale) pain and IKDC (International Knee Documentation Committee) scores at time periods up to 6 weeks, at 3 and 6 months. The level of bias was assessed with the use of the Cochrane Risk of Bias 2. Cochrane RevMan Web was used for data analysis. The guidelines of PRISMA 2020 (Preferred Reporting Items of Systematic Reviews and Meta-Analyses) were followed.

Eighteen RCTs with a total of 971 patients were included in the meta-analysis. The meta-analysis revealed that the patients with KOA reported a systematic subjective improvement seen on the WOMAC, IKDC and VAS pain scores after intra-articular administration of PRP. Importantly, the results reached their peak and the values exceeded the minimal clinically important difference at 3 and 6 months after administration. When compared to placebo and hyaluronic acid, the intra-articular administration of PRP achieved better results.

Intra-articular administration of PRP in the treatment of KOA is a popular treatment modality appreciated by orthopaedic surgeons, rheumatologists as well as patients. Depending on the initial assessment, the PRP treatment offers pain relief for up to 12 months after administration, together with a marked improvement in function of the affected knee. Even though the PRP is frequently administered in the clinical practice, it is not recommended by prestigious professional medical societies because of its relatively small effect and the absence of knowledge concerning the optimal patient responding reliably to this method. In our study, however, a consistent pain relief and functional improvement was shown in KOA patients after the PRP administration, experienced over a period of months. We therefore assume that based on our findings the Czech Society for Orthopaedics and Traumatology and the Czech Society of Rheumatology could enlist PRP among the recommended non-operative KOA treatment modalities.