Comparison of the Clinical Effectiveness of Single Versus Multiple Injections of Platelet-Rich Plasma in the Treatment of Knee Osteoarthritis: A Systematic Review and Meta-analysis

Félix Vilchez-Cavazos, Juan Manuel Millán-Alanís, Jaime Blázquez-Saldaña, Neri Álvarez-Villalobos, Víctor Manuel Peña-Martínez, Carlos Alberto Acosta-Olivo, Mario Simental-Mendía, Félix Vilchez-Cavazos, Juan Manuel Millán-Alanís, Jaime Blázquez-Saldaña, Neri Álvarez-Villalobos, Víctor Manuel Peña-Martínez, Carlos Alberto Acosta-Olivo, Mario Simental-Mendía

Abstract

Background: Reports have concluded that platelet-rich plasma (PRP) is an effective and safe biological approach in the treatment of knee osteoarthritis (OA). However, no consensus has been established regarding the number of injections required to observe a therapeutic effect.

Purpose: To compare the clinical effectiveness reported in randomized controlled trials (RCTs) of single versus multiple PRP injections in the treatment of knee OA.

Study design: Systematic review; Level of evidence, 1.

Methods: A comprehensive search was conducted for RCTs published between 1970 and 2019 that compared the effect of single versus multiple PRP injections on pain and functionality in patients with knee OA. Searched databases included MEDLINE, Scopus, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials. A data extraction form was designed to obtain bibliographic information of the study as well as patient, intervention, comparison, and outcomes of interest data. A random-effects model was used to pool quantitative data from the primary outcomes.

Results: We included 5 clinical trials with a low-moderate risk of bias that reported data for 301 patients. Meta-analysis showed that, at 6 months after the intervention, single and multiple (double or triple) injections had similar pain improvement, with no significant differences (standardized mean difference [SMD], 0.61 [95% CI, -1.09 to 2.31]; I 2 = 97%; P = .48). A significant improvement in knee functionality was observed in favor of multiple injections (SMD, 2.29 [95% CI, 0.45-4.12]; I 2 = 97%; P = .01). Subanalysis showed that the significant improvement was only evident for the results of single versus triple injections (SMD, 3.12 [95% CI, 0.64-5.60]; I 2 = 97%; P = .01).

Conclusion: According to our results, a single injection was as effective as multiple PRP injections in pain improvement; however, multiple injections seemed more effective in joint functionality than a single injection at 6 months. We consider that the available evidence is still insufficient, and future research on this specific topic is needed to confirm our results.

Keywords: functionality; injection; knee osteoarthritis; meta-analysis; platelet-rich plasma.

Conflict of interest statement

The authors declared that there are no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

© The Author(s) 2019.

Figures

Figure 1.
Figure 1.
Flowchart of the number of studies identified and included in this meta-analysis. RCT, randomized controlled trial.
Figure 2.
Figure 2.
Quality of bias assessment of the included studies according to the Cochrane guidelines. “+” indicates low risk of bias; “−” indicates high risk of bias; “?” indicates unclear risk of bias.
Figure 3.
Figure 3.
Forest plot displaying the standardized mean difference and 95% confidence interval for the impact of treatment with single or multiple platelet-rich plasma injections on pain (visual numerical scale and visual analog scale).
Figure 4.
Figure 4.
Forest plot displaying the standardized mean difference and 95% confidence interval for the impact of treatment with single or multiple platelet-rich plasma injections on joint function (Western Ontario and McMaster Universities Arthritis Index and International Knee Documentation Committee).

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Source: PubMed

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