Platelet rich plasma versus hyaluronic acid in treatment of knee osteoarthritis: an overview of systematic reviews

doi:10.12307/2025.459

Abstract

Abstract: OBJECTIVE: The quality of systematic reviews/meta-analyses directly affects the reliability of clinical decision-making basis. Currently, there is no literature quality research on the systematic reviews/meta-analyses of platelet rich plasma versus hyaluronic acid in the treatment of knee osteoarthritis both domestically and internationally. This article will comprehensively evaluate the methodological quality, reporting quality, and evidence quality of the systematic reviews/meta-analyses of platelet rich plasma versus hyaluronic acid in the treatment of knee osteoarthritis.
METHODS: Computer searches were conducted on CNKI, WanFang Data, VIP, CBM, PubMed, Embase, and The Cochrane Library. From the establishment of the database until January 24, 2024, all systematic reviews/meta-analyses treated with platelet rich plasma versus hyaluronic acid for knee osteoarthritis were collected. Two evaluators independently conducted literature screening and data extraction, and used the AMSTAR 2, PRISMA 2020, and GRADE systems to evaluate and summarize the methodological, reporting, and evidence quality of the included systematic reviews/meta-analyses.
RESULTS: A total of 18 qualified systematic reviews/meta-analyses were included, and the results showed that the efficacy and safety of platelet rich plasma might be better than that of hyaluronic acid. The methodological quality of all 18 studies was extremely low; 4 reports had poor quality and relatively serious information defects, while 14 reports had moderate quality and some information defects. Among the 275 outcome measures of 16 systematic reviews/meta-analyses, there were 9 medium quality evidence, 90 low-quality evidence, and 176 extremely low-quality evidence, with no high-quality evidence.
CONCLUSION: At present, the quality of systematic reviews/meta-analyses literature on the treatment of knee osteoarthritis with platelet rich plasma versus hyaluronic acid is relatively low. In the future, the authors of the systematic reviews need to strictly follow the entries of quality evaluation tools such as AMSTAR 2 and PRISMA 2020 in terms of plan registration, research type explanation, retrieval strategy, exclusion list, research site and funding source, bias risk analysis, publication bias evaluation, and public information acquisition, and conduct evidence quality evaluation on the combined results of the systematic reviews/meta-analyses to provide more reliable and rigorous evidence-based basis for clinical practice.

Key words: platelet rich plasma, hyaluronic acid, knee osteoarthritis, overview of systematic reviews, AMSTAR 2, PRISMA 2020, GRADE system

CLC Number:

Zhang Yunyi, Liu Songtao, Xie Shaodong, Zhu Haifeng, Qian Guifeng, Huo Ming, Zhou Jie, Deng Zixuan. Platelet rich plasma versus hyaluronic acid in treatment of knee osteoarthritis: an overview of systematic reviews[J]. Chinese Journal of Tissue Engineering Research, 2025, 29(28): 6138-6145.

Figures/Tables 5

2.2 纳入研究基本特征研究共纳入18篇系统评价/Meta分析[8-25]，其中8篇为中文文献[8-15]，10篇为英文文献[16-25]，均发表在2016-2023年间。在18篇系统评价/Meta分析中，纳入的原始研究数量在6-21篇之间，样本量在722-2 086例之间，所有研究类型均为随机对照试验，其中1篇文献明确提出试验组的干预措施采用贫白细胞富血小板血浆[12]，1篇试验组的干预措施为富白细胞富血小板血浆[18]，2篇试验组包含贫白细胞富血小板血浆和富白细胞富血小板血浆[17，19]，1篇比较多次富血小板血浆与多次透明质酸注射的疗效[16]，其余文献仅说明富血小板血浆与透明质酸的对比[8-11，13-15，20-25]。在对纳入原始研究的方法学质量评价工具选择中，仅采用Cochrane工具的文献有12篇[8-11，13-15，18，21-24]，仅采用Jadad量表的有1篇[16]，同时使用Cochrane工具、Jadad量表的有3篇[12，20，25]，同时使用Cochrane工具、Modified Coleman Methodology Score评分的有2篇[17，19]。仅有WOMAC被所有文献作为结局指标。所有文献均认为富血小板血浆治疗膝骨关节炎的疗效可能优于透明质酸，有7篇文献明确提出富血小板血浆治疗膝骨关节炎的远期疗效优于透明质酸[9-10，13-14，21，3]，2篇认为富血小板血浆治疗膝骨关节炎具有高安全性[21，23]，有5篇则说明富血小板血浆与透明质酸治疗膝骨关节炎的安全性无明显差异[9-11，13-14]，所有研究均表明需要更严谨的随机对照试验设计进行验证。 1篇文献仅纳入国内的原始研究[13]，1篇仅纳入超重或肥胖的膝骨关节炎患者[22]，1篇明确规定试验组和对照组采用相同的注射频率、注射周期[20]，所有文献均未统一富血小板血浆和玻璃酸钠的型号、制备方式、注射剂量、间隔时间等因素。纳入研究的基本特征详见表1。"

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