BACKGROUND: Hyaluronic acid is a commonly used drug in the treatment of knee osteoarthritis, and platelet-rich plasma is a research hotspot in recent years. There is still controversy on the comparison of the effectiveness and safety between them.
OBJECTIVE: To systematically assess the efficacy and safety of platelet-rich plasma and hyaluronic acid for knee osteoarthritis through a meta-analysis.
METHODS: The authors systematically retrieved the databases of CNKI, VIP, Wanfang, CBM, PubMed, EMBase and Cochrane Library for randomized controlled trials regarding platelet-rich plasma versus hyaluronic acid for knee osteoarthritis published from inception to January 2020. Quality assessment was conducted on eligible randomized controlled trials. A meta-analysis was performed in WOMAC score, IKDC score, visual analogue scale score, Lequesne index and adverse events using RevMan 5.3 software.
RESULTS AND CONCLUSION: (1) Totally 21 randomized controlled trials were eventually included,involving 1 872 knees including 963 patients in the platelet-rich plasma group and 909 patients in the hyaluronic acid group. (2) Meta-analysis results showed that WOMAC scores were significantly lower in the platelet-rich plasma group than in the hyaluronic acid group at 3, 6 and 12 months after treatment [MD=-5.84, 95%CI(-10.11, -1.57), P=0.007; MD=-9.48, 95%CI(-13.02, -5.95), P < 0.000 01; MD=-10.47, 95%CI(-13.95, -7.00), P < 0.000 01]. Visual analogue scale scores were lower in the platelet-rich plasma group than in the hyaluronic acid group at 6 and 12 months after treatment [MD=-5.02, 95%CI(-8.87, -1.18), P=0.01; MD=-3.33, 95%CI(-4.89, -1.76), P < 0.000 1]. IKDC scores were higher in the platelet-rich plasma group than in the hyaluronic acid group at 3, 6, and 12 months after treatment [MD=7.10, 95%CI(3.88, 10.32), P < 0.000 1; MD=7.88, 95%CI(5.12, 10.65), P < 0.000 01; MD=6.85, 95%CI(2.50, 11.19), P=0.002]. Lequesne Index scores were lower in the platelet-rich plasma group than in the hyaluronic acid group at 6 and 12 months after treatment [MD=-0.82, 95%CI(-1.31, -0.32), P=0.001; MD=-2.37, 95%CI(-2.93, -1.81), P < 0.000 01]. No significant difference was found in adverse event rates between the two groups [OR=1.46, 95%CI(0.94, 2.24), P=0.09]. (3) The results show that compared with hyaluronic acid, platelet-rich plasma can relieve pain, improve function, improve the quality of life of patients with knee osteoarthritis, and the effect is more lasting.