Comparing efficacy of intraarticular single crosslinked Hyaluronan (HYAJOINT Plus) and platelet-rich plasma (PRP) versus PRP alone for treating knee osteoarthritis

AbstractIntraarticular hyaluronan or platelet-rich plasma (PRP) is widely used in the treatment of knee osteoarthritis (OA). The efficacy of combined hyaluronan with PRP remained inconclusive. This study aimed to investigate the efficacy of combined a single crosslinked hyaluronan (HYAJOINT Plus) and a single PRP versus a single PRP in patients with knee OA. In a prospective randomized-controlled trial, 85 patients with knee OA (Kellgren-Lawrence 2) were randomized to receive a single intraarticular injection of HYAJOINT Plus (3 ml, 20 mg/ml) followed by 3 ml PRP (the combined-injection group, N = 43) or a single injection of 3 ml PRP (the one-injection group, N = 42). The primary outcome was the change from baseline in the visual analog scale (VAS) pain (0–00 mm) at 6 months. Secondary outcomes included The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC, Likert Scale), Lequesne index, single leg stance test (SLS), use of rescue analgesics and patient satisfaction at 1, 3 and 6 months. Seventy-eight patients were available for the intention-to-treat analysis at 6 months. Both groups improved significantly in VAS pain, WOMAC, Lequesne index and SLS at each follow-up visit (p < 0.001). Patients receiving a single PRP experienced significantly greater improvements in VAS pain than patients receiving combined injections at 1-month follow-up (adjusted mean difference: − 5.6; p = 0.017). There were no significant between-group differences in several of the second outcomes at each follow-up visit, except the WOMAC-pain and WOMAC-stiffness scores favoring the one-injection group at 1 month (p = 0.025 and p = 0.011). However, at 6-month follow-up, the combined-injection group achieved significantly better VAS pain reduction (p = 0.020). No serious adverse events occurred following injections. In conclusion, either combined injections of HYAJOINT Plus and PRP or a single PRP alone was safe and effective for 6 months in patients with Kellgren-Lawrence 2 knee OA. Combined injections of HYAJOINT Plus and PRP achieved better VAS pain reduction than a single PRP at 6 months. The results indicating a long term benefit effect of a combination of HYAJOINT Plus and PRP in a particular subset of patients with moderate knee OA need to be replicated in larger trials.ClinicalTrials.gov number NCT04315103.

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Effects and safety of platelet-rich plasma (PRP) and hyaluronic acid (HA), alone and in combination, in the treatment of knee osteoarthritis: A systematic review and meta-analysis.

10.21203/rs.2.23232/v1 ◽

2020 ◽

Author(s):

Jinlong Zhao ◽

Hetao Huang ◽

Guihong Liang ◽

Ling-feng Zeng ◽

Weiyi Yang ◽

...

Keyword(s):

Hyaluronic Acid ◽

Knee Osteoarthritis ◽

Knee Pain ◽

Platelet Rich Plasma ◽

Meta Analysis ◽

Cochrane Library ◽

China National Knowledge Infrastructure ◽

Womac Function ◽

Lequesne Index

Abstract Background Studies have shown that the combined application of hyaluronic acid (HA) and platelet-rich plasma (PRP) can repair degenerated cartilage and delay the progression of knee osteoarthritis (KOA). The purpose of this study was to explore the efficacy and safety of PRP combined with HA in the treatment of KOA compared with intra-articular injection of PRP or HA alone. Methods The PubMed, Cochrane Library, EMBASE and China National Knowledge Infrastructure (CNKI) databases were searched from inception to December 2019. Two orthopaedic surgeons conducted the literature retrieval and extracted the data. Outcome indicators include the Western Ontario and McMaster Universities Arthritis Index (WOMAC), the Lequesne Index, the visual analogue scale (VAS) for pain, and adverse events (AEs). Results Seven studies (5 randomized controlled trials, 2 cohort studies) with a total of 941 patients were included. In the VAS comparison after 6 months of follow-up, PRP combined with HA was more likely to reduce knee pain than PRP alone (standardized mean difference (SMD): -0.31; 95% confidence interval (CI): -0.55 to -0.06; P=0.01 <0.05). PRP combined with HA for KOA achieved better improvement in WOMAC Function Score (SMD: -0.32; 95% CI: -0.54 to -0.10) and WOMAC Total Score (SMD: -0.42; 95% CI: -0.67 to -0.17) at the 12-month follow-up than the application of PRP alone. In a comparison of Lequesne Index scores at a 6-month follow-up, PRP combined with HA improved knee pain scores more than PRP alone (SMD: -0.42; 95% CI: -0.67 to -0.17). In terms of AEs, PRP combined with HA was not significantly different from PRP or HA alone (P>0.05). Conclusions Compared with intra-articular injection of PRP alone, PRP combined with HA can improve WOMAC Function Scores, WOMAC Total Score, 6-month follow-up VAS ratings, and Lequesne Index scores. However, in terms of the incidence of AEs, PRP combined with HA was not significantly different from PRP or HA alone.

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Comparison of the clinical effect of intra-articular injection of platelet-rich plasma and methylprednisolone in primary osteoarthritis of knee: a randomized controlled trial

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20195238 ◽

2019 ◽

Vol 6 (6) ◽

pp. 1842

Author(s):

Darendrajit S. Longjam ◽

Joy S. Akoijam ◽

Meina S. Ahongshangbam ◽

Nilachandra S. Longjam

Keyword(s):

Rural Areas ◽

Urban Areas ◽

Platelet Rich Plasma ◽

Controlled Trial ◽

Osteoarthritis Of The Knee ◽

Womac Pain ◽

Osteoarthritis Of Knee ◽

Primary Osteoarthritis ◽

Steroid Group

Background: Osteoarthritis of knee is one of the commonest musculoskeletal disorder causing mobility impairment affecting 3.3% in urban areas and 5.5% in rural areas. Intra-articular injection of Platelet-Rich Plasma (PRP) delivers activated platelets that may reduce inflammation, provide pain relief, improve function and stimulate possible cartilage regeneration at the site of worn cartilage area of the knee.Methods: Eighty patients with primary osteoarthritis of the knee fulfilling inclusion and exclusion criteria were recruited in the study conducted in the Department of Physical Medicine and Rehabilitation, RIMS, Imphal from October 2014 to September 2017. Six ml of PRP prepared by conventional bench top centrifugation system was injected intra-articularly, two weeks apart in the PRP group. Steroid group received 80mg of methylprednisolone, two weeks apart by the same technique. The outcome variables (VAS and WOMAC score) were measured before starting intervention (baseline) and at 8 and 24-weeks post-intervention follow up.Results: Significant improvement seen in VAS, WOMAC-pain, stiffness and physical function and total scores in both the groups at 8- and 24-weeks follow-ups (p˂0.001). Steroid group showed better result than the PRP group in VAS (2.78±0.76 vs 3.58±1.03) and WOMAC-total (30.42±6.85 vs 36.25±10.87) scores at 8 weeks respectively (p˂0.001). But at 24 weeks follow-up, PRP showed significantly more effective than the steroid group in reducing pain (2.0±.0.87 vs 2.45±0.78) and disability (22.95±3.78 vs 25.25±6.67) respectively (p˂0.001).Conclusions: Intra-articular injection of methylprednisolone was found to be more effective in reducing pain and disability in primary knee osteoarthritis of KL grade 2 and 3 at the end of 8 weeks whereas 2 doses of PRP intra-articular injection 2 weeks apart was significantly more effective than methylprednisolone at the end of 24 weeks. However, the long-term benefit of PRP is to be determined by studies with a larger sample size and longer duration of follow-up.

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Comparative study between the effect of neural versus intra-articular dextrose prolotherapy on pain and disability in patients with knee osteoarthritis

Egyptian Rheumatology and Rehabilitation ◽

10.1186/s43166-021-00079-w ◽

2021 ◽

Vol 48 (1) ◽

Author(s):

Rehab A. Sallam ◽

Aya A. Abdelkhabir ◽

Adel A. Shabana

Keyword(s):

Knee Osteoarthritis ◽

Womac Pain ◽

Knee Oa ◽

Natural Substances ◽

Group I ◽

Skin Targeting ◽

Vas Scores ◽

Group Ii ◽

Reduced Mobility

Abstract Background Osteoarthritis (OA) is a degenerative disease which presents with joint pain and stiffness and reduced mobility. Knee OA is the commonest cause of disability in adults. Dextrose prolotherapy is a new option used to treat mild-to-moderate knee OA. Neural prolotherapy (NPT) is multiple small injections under the skin targeting painful areas with natural substances. The aim of work was to evaluate and compare neural prolotherapy versus intra-articular dextrose prolotherapy effect on relieving pain and improving disability of knee OA. Results VAS and WOMAC scores improved significantly immediately and at 3 and at 6 months, respectively, in group I compared with group II (P < 0.001). The decrease in VAS scores and all the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores in group I along the follow-up period in comparison with the baseline scores was statistically significant (P < 0.001). In group II, only WOMAC pain and stiffness scores improved significantly. ROM showed insignificant increase in both groups at 3 and 6 months assessment. On follow-up, range of motion increased in both groups and reached significance in group I (P = .002). Conclusion Dextrose prolotherapy both intra-articular and periarticular (neural) is a very effective and cheap therapy for knee OA with good patient selection. Neural prolotherapy significantly relieves pain and improves function in patients with knee osteoarthritis when compared with intra-articular prolotherapy thus avoiding hazards of intra-articular knee injections.

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T2 mapping evaluation of changes in cartilage matrix after PRP and HA injection therapy in knee osteoarthritis: a prospective, randomized, double blind, placebo controlled study

10.21203/rs.3.rs-36493/v1 ◽

2020 ◽

Author(s):

Matjaz Vogrin ◽

Jakob Naranda ◽

Mario Gorenjak ◽

Tomaz Bajec ◽

Domen Mongus ◽

...

Keyword(s):

Placebo Group ◽

Knee Osteoarthritis ◽

Pain Score ◽

T2 Mapping ◽

Womac Score ◽

Controlled Study ◽

Womac Pain ◽

Womac Pain Score ◽

Knee Oa

Abstract BackgroundIn this study we focused on evaluating the effect of intra-articular platelet-rich plasma (PRP) and hyaluronic acid (HA) on the qualitative and quantitative properties of the articular cartilage in patients with knee osteoarthritis (OA).MethodsWe evaluated 264 patients undergoing treatment of moderate knee OA. Patients aged between 40 and 70 years were included with articular K-L stage ≤ 2. Patients were randomized into three groups and treated with three doses of intra-articular PRP, HA, or placebo injection. Patients were evaluated clinically and by using T2 mapping.ResultsBoth PRP (619.05 ± 243 ms; p = 2.7 × 10− 5) and HA (637.12 ± 273 ms; p = 1.×10− 4) group showed statistically significant lower post-application T2 relaxation times in comparison to the placebo group (859.80 ± 406 ms).Cartilage thickness increased significantly after PRP (2.41±0.87 vs. 2.58±0.97 mm, p=0.033) and HA (2.28±0.81 vs. 2.80±1.00 mm, p=1.8×10) applications. There was a significant decrease in WOMAC pain score by 30% (p=0,001) and the overall WOMAC score by 27 p=1.9×10-4%) in PRP group. The decrease in WOMAC pain score and the overall WOMAC score in the placebo group was similar to the results observed in the PRP group. In the HA group a significant decrease in WOMAC pain score by 14% (p=0,005) was observed only at the first follow-up, whereas no difference was observed at the second follow-up. ConclusionsT2 mapping of cartilage tissue may aid to monitor its properties after the intra-articular therapies in knee OA. However, there is a discrepancy between clinical findings and the results of T2 mapping, suggesting questionable grounds for applying intra-articular therapy.

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Effectiveness of Platelet Rich Plasma for the Management of Knee Osteoarthritis

10.53350/pjmhs211571553 ◽

2021 ◽

Vol 15 (7) ◽

pp. 1553-1556

Author(s):

Adnan Qamar ◽

Saima Naz Mohsin ◽

Uzma Nasim Siddiqui ◽

Sana Naz ◽

Sana Danish

Keyword(s):

Knee Osteoarthritis ◽

Normal Saline ◽

Platelet Rich Plasma ◽

Controlled Trial ◽

Saline Group ◽

Control Group ◽

Plasma Therapy ◽

Vas Score ◽

To Receive

Aim: To determine impact of platelet rich plasma therapy for the management of knee osteoarthritis. Study design: Prospective double-blinded, add –on randomized, placebo-controlled trial Place and duration of study: Department of Orthopedics, Shaikh Zayed Hospital Lahore from 1st January 2019 to 30th June 2019 Methodology: Fifty volunteer participants fulfilling inclusion criteria were enrolled. One hundred knees of patients were randomly allocated into two groups. Knees were assigned either of the two groups. Platelet rich plasma group which was assigned to receive 5ml of platelet rich plasma and normal saline (NS) group which was assigned to receive 5ml of NS labeled as control group. All patients given 3 successive intra-articular injections of 5 mL of autologous platelet rich plasma or 5ml of normal saline was given at weekly intervals. Patients were blinded and subjected to a standardized injection protocol and the intensity of pain was assessed on visual analog scale (VAS) for pain. Results: The VAS scores decreased from 50.9±14.7 at baseline assessment to 43.6±16.2 at 1-month follow-up after completion of therapy for PRP group (p<0.0203). The improvement was maintained from the end of the therapy to 3 and 6 months’ follow-up, as measure of VAS score as 30.54±11.8 and 20.2±8.6 respectively (p<0.0001). In normal saline group, there was very slight decrease in VAS score from baseline i.e. 49.8±19.5 to 48±22.7, 44±16.6, and 42±21.7 at 1, 3 and 6 months interval. Conclusion: Platelet rich plasma therapy can provide effective pain control up to 6 months post injection in knee osteoarthritis. Key words: Platelet rich plasma (PRP), Knee osteoarthritis (OA), Pain score

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Depression in patients with knee osteoarthritis: risk factors and associations with joint symptoms

10.21203/rs.3.rs-31807/v2 ◽

2020 ◽

Author(s):

Shuang Zheng ◽

Liudan Tu ◽

Flavia Cicuttini ◽

Zhaohua Zhu ◽

Weiyu Han ◽

...

Keyword(s):

Risk Factors ◽

Knee Joint ◽

Knee Osteoarthritis ◽

Controlled Trial ◽

Womac Pain ◽

Knee Oa ◽

Symptomatic Knee Osteoarthritis ◽

Symptomatic Knee ◽

Joint Symptoms ◽

Patient Health

Abstract Background:To describe demographic and clinical factors associated with the prevalence and incidence of depression and explore the temporal relationship between depression and joint symptoms in patients with symptomatic knee osteoarthritis (OA). Methods:413 participants were selected from a randomized controlled trial in people with symptomatic knee OA and vitamin D deficiency (age 63.2 ± 7.0 year, 50.4% female). Depression severity and knee joint symptoms were assessed using the patient health questionnaire (PHQ-9) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), respectively, at baseline and 24 months. Results: The prevalence and incidence of depression was 25.4% and 11.2%, respectively. At baseline, having younger age, a higher body mass index (BMI), greater scores of WOMAC pain (PR: 1.05, 95%CI:1.03, 1.07), dysfunction (PR: 1.02, 95%CI:1.01, 1.02) and stiffness (PR: 1.05, 95%CI: 1.02, 1.09), lower education level, having more than one comorbidity and having two or more painful body sites were significantly associated with a higher prevalence of depression. Over 24 months, being female, having a higher WOMAC pain (RR: 1.05, 95%CI: 1.02, 1.09) and dysfunction score (RR: 1.02, 95%CI: 1.01, 1.03) at baseline and having two or more painful sites were significantly associated with a higher incidence of depression. In contrast, baseline depression was not associated with changes in knee joint symptoms over 24 months. Conclusion: Knee OA risk factors and joint symptoms, along with co-existing multi-site pain are associated with the prevalence and development of depression. This suggests that managing common OA risk factors and joint symptoms may be important for prevention and treatment depression in patients with knee OA.Trial registration: ClinicalTrials.gov identifier: NCT01176344Anzctr.org.au identifier: ACTRN12610000495022

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Platelet-rich plasma versus hyaluronic acid in the treatment of knee osteoarthritis: a meta-analysis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-01919-9 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Jia Zhu Tang ◽

Ming Jun Nie ◽

Jian Zhong Zhao ◽

Guang Cheng Zhang ◽

Qing Zhang ◽

...

Keyword(s):

Hyaluronic Acid ◽

Adverse Events ◽

Knee Osteoarthritis ◽

Platelet Rich Plasma ◽

Meta Analysis ◽

Womac Pain ◽

Significant Difference ◽

Vas Scores ◽

Eq Vas

Abstract Background This study aimed to evaluate the clinical efficacy of platelet-rich plasma (PRP) injection compared with hyaluronic acid (HA) injection for patients undergoing knee osteoarthritis. Methods We systematically searched electronic databases including PubMed, Embase, Web of Science, and the Cochrane Library on January 23, 2020 to identify relevant studies issued in English languages. The outcomes evaluating the efficacy of knee osteoarthritis (KOA) treatment were Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores (WOMAC pain, function, stiffness, and total scores) at 1, 3, 6, and 12 months; International Knee Documentation Committee (IKDC) scores, Lequesne Index score, Visual Analog Scale (VAS) scores, EQ-VAS scores, and KOOS scores. The pooled data were analyzed by Stata 12.0. Results A total of 20 RCTs were enrolled in the present meta-analysis. The pooled results demonstrated that platelet-rich plasma (PRP) injection reduced pain more effectively than hyaluronic acid (HA) injection at 6-month and 12-month follow-up evaluated by WOMAC pain scores and VAS scores. EQ-VAS in the patients treated with PRP injection was lower than that in patients with HA injection at 12 months. Moreover, the patients with PRP injection had a better function recovery than those with HA injection at 1-month, 3-month, 6-month, and 12-month follow-up, as evaluated by WOMAC function scores. WOMAC total scores showed significant difference at 6-month and 12-month follow-up. The IKDC scores indicated PRP injection was significantly more effective than HA injection at 3 months and 6 months. However, the Lequesne Index scores, KOOS scores, and adverse events did not show any significant difference between groups. Conclusion Intra-articular PRP injection appeared to be more efficacious than HA injection for the treatment of KOA in terms of short-term functional recovery. Moreover, PRP injection was superior to HA injection in terms of long-term pain relief and function improvement. In addition, PRP injection did not increase the risk of adverse events compared to HA injection.

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How to Choose Platelet-Rich Plasma or Hyaluronic Acid for the Treatment of Knee Osteoarthritis in Overweight or Obese Patients: A Meta-Analysis

Pain Research and Management ◽

10.1155/2020/7587936 ◽

2020 ◽

Vol 2020 ◽

pp. 1-12

Author(s):

Pan Luo ◽

Zhencheng Xiong ◽

Wei Sun ◽

Lijun Shi ◽

Fuqiang Gao ◽

...

Keyword(s):

Hyaluronic Acid ◽

Knee Osteoarthritis ◽

Platelet Rich Plasma ◽

Meta Analysis ◽

Cochrane Library ◽

Obese Patients ◽

Knee Oa ◽

Significant Difference ◽

Better Than

Objective. The purpose of this meta-analysis was to determine whether platelet-rich plasma (PRP) was better than hyaluronic acid (HA) for the treatment of knee osteoarthritis (OA) in overweight or obese patients. Design. Two reviewers independently used the keywords combined with free words to search English-based electronic databases according to Cochrane Collaboration guidelines, such as PubMed, Embase, ScienceDirect, and Cochrane library. The pooled data were analyzed using RevMan 5.3. Results. Ten randomized controlled trials (RCTs) with 1096 patients were included. During the first two months of follow-up, there was no significant difference between the two groups. At the 3rd, 6th, and 12th months of follow-up, the pooled analysis showed that PRP was better than HA for the treatment of knee OA in overweight or obese patients. There were significant differences between the two groups at Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score (3 months: MD = −1.35, [95% CI: −2.19 to −0.50], P=0.002, I2 = 0%; 6 months: MD = −7.62, [95% CI: −13.51 to −1.72], P=0.01, I2 = 88%; 12 months: MD = −12.11, [95% CI: −20.21 to −4.01], P=0.003, I2 = 94%). Conclusions. For overweight or obese patients with knee OA, intra-articular injection of PRP in a short time was not necessarily superior to HA, but long-term use was better than HA in pain and functional relief.

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A Randomised Placebo-Controlled Trial to Assess the Efficacy of Osteoarthritic nosode in the Treatment of Knee Osteoarthritis

Homœopathic Links ◽

10.1055/s-0041-1735488 ◽

2021 ◽

Vol 34 (03) ◽

pp. 199-205

Author(s):

Reteka Sexena ◽

Tarkeshwar Jain

Keyword(s):

Knee Osteoarthritis ◽

Daily Living ◽

Controlled Trial ◽

Research Centre ◽

Functional Domains ◽

Functional Domain ◽

Knee Oa ◽

Group A ◽

Group B

Abstract Background Knee osteoarthritis (OA) is the most common musculoskeletal disease that affects the ability for sitting on the chair, standing, walking and climbing stairs and various other daily living activities of an affected individual. Objective The primary objective of the study was to assess the efficacy of Osteoarthritic nosode in the treatment of knee OA on the symptomatic and functional domains in comparison to control group with knee-specific exercises as co-intervention in both the groups. Materials and Methods It was a single blind randomised controlled trial study conducted at the out/inpatient department of Dr Madan Pratap Khunteta Homoeopathic Medical College, Hospital & Research Centre and Dr Girendra Pal Homoeopathic Hospital, Homoeopathy University, Saipura, Sanganer, Jaipur for a period of 1 year where cases were registered for first 9 months so that minimum of 3 months follow-up can be obtained during the course of the study. Total 50 patients who were radiographically diagnosed to be suffering from knee OA excluding Grade 4 of knee OA were allocated equally and randomly into two treatment groups. The patients in Group A received placebo and physiotherapy and patients in Group B received Osteoarthritic nosode and physiotherapy. The changes in patients' symptomatic and functional domain were evaluated by Knee Outcome Survey-Activity of Daily Living Scale (KOS- ADLS) questionnaire score assessed at the baseline and after 3 months (six follow-ups at 15 days interval) of treatment. Results Out of 50 patients enrolled, 45 patients completed the trial. Those patients who had completed 3 months of follow-up, that is, 6 follow-ups at 15 days interval, were included in the study. The results showed that the patients with knee OA in Group B had significant improvement in both symptomatic and functional domains after treatment when compared with their initial status and when compared with Group A. Group A (placebo and physiotherapy) showed non-significant to no improvement in 72% of cases and 16% were aggravated when assessed on the symptomatic and functional domains. Group B (OA nosode and physiotherapy) showed mild to marked improvement in 80% of cases, whereas 12% showed non-significant to no improvement when assessed on the symptomatic and functional domains. Conclusion Osteoarthritic nosode with physiotherapy is significantly effective than placebo with physiotherapy in the management of cases of knee OA.

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Intra-articular platelet-rich plasma injections versus intra-articular corticosteroid injections for symptomatic management of knee osteoarthritis: systematic review and meta-analysis

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04308-3 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Michael McLarnon ◽

Neil Heron

Keyword(s):

Knee Osteoarthritis ◽

Platelet Rich Plasma ◽

Risk Of Bias ◽

Post Intervention ◽

Promising Alternative ◽

Knee Oa ◽

Sporting Activity ◽

Symptomatic Management ◽

Corticosteroid Injections

Abstract Background Intra-articular (IA) corticosteroid (CS) injections are the mainstay of treatment for symptomatic management in knee osteoarthritis (OA), particularly in the UK. IA platelet-rich plasma (PRP) injections are a promising alternative, but no systematic reviews to date have compared them to the current standard of care, IA CS injections. We aim to investigate the effect of IA PRP injections versus IA corticosteroid injections for the symptomatic management of knee OA. Methods All published trials comparing IA PRP and CS injections for knee OA were included. MEDLINE, EMBASE, Scopus and Web of Science were searched through June 2020. Risk of bias was assessed using the Cochrane Risk of Bias tool. A random effects model was used to calculate standardized mean difference with 95% confidence interval in WOMAC/VAS score (or subscores), comparing IA PRP to CS injections across studies. Results Included were eight studies and 648 patients, 443 (68%) were female, mean age 59 years, with a mean BMI of 28.4. Overall, the studies were considered at low risk of bias. Compared with CS injections, PRP was significantly better in reducing OA symptoms (pain, stiffness, functionality) at 3, 6 and 9 months post-intervention (P < 0.01). The greatest effect was observed at 6 and 9 months (− 0.78 (− 1.34 to − 0.23) standard mean deviations (SMD) and − 1.63 (− 2.14 to − 1.12) SMD respectively). At 6 months, this equates to an additional reduction of 9.51 in WOMAC or 0.97 on the VAS pain scales. At 6 months PRP allowed greater return to sporting activities than CS, measured by the KOOS subscale for sporting activity, of magnitude 9.7 (− 0.45 to 19.85) (P = 0.06). Triple injections of PRP, generally separated by a week, were superior to single injections over 12 months follow-up (P < 0.01). Conclusions IA-PRP injections produce superior outcomes when compared with CS injections for symptomatic management of knee OA, including improved pain management, less joint stiffness and better participation in exercise/sporting activity at 12 months follow-up. Giving three IA-PRP, with injections separated by a week, appears more effective than 1 IA-PRP injection. Prospero trial registration number CRD42020181928.

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