PRP Injections for the Treatment of Knee Osteoarthritis: A Meta-Analysis of Randomized Controlled Trials

Giuseppe Filardo, Davide Previtali, Francesca Napoli, Christian Candrian, Stefano Zaffagnini, Alberto Grassi, Giuseppe Filardo, Davide Previtali, Francesca Napoli, Christian Candrian, Stefano Zaffagnini, Alberto Grassi

Abstract

Objective: To evaluate effectiveness, in terms of patient-reported outcome measures, of platelet-rich plasma (PRP) injections for knee osteoarthritis compared to placebo and other intraarticular treatments.

Design: PubMed, Cochrane Library, Scopus, Embase, Web of Science, as well as the gray literature were searched on January 17, 2020. Randomized controlled trials (RCTs) comparing PRP injections with placebo or other injectable treatments, in any language, on humans, were included. Risk of bias was assessed following the Cochrane guidelines; quality of evidence was graded using the GRADE guidelines.

Results: Thirty-four RCTs, including 1403 knees in PRP groups and 1426 in control groups, were selected. WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) score favored PRP, with a statistically and clinically significant difference versus placebo at 12-month follow-up (P = 0.02) and versus HA (hyaluronic acid) at 6-month (P < 0.001) and 12-month (P < 0.001) follow-ups. A clinically significant difference favoring PRP versus steroids was documented for VAS (Visual Analogue Scale) pain (P < 0.001), KOOS (Knee Injury and Osteoarthritis Outcome Score) pain (P < 0.001), function in daily activities (P = 0.001), and quality of life (P < 0.001) at 6-month follow-up. However, superiority of PRP did not reach the minimal clinically important difference for all outcomes, and quality of evidence was low.

Conclusions: The effect of platelet concentrates goes beyond its mere placebo effect, and PRP injections provide better results than other injectable options. This benefit increases over time, being not significant at earlier follow-ups but becoming clinically significant after 6 to 12 months. However, although substantial, the improvement remains partial and supported by low level of evidence. This finding urges further research to confirm benefits and identify the best formulation and indications for PRP injections in knee OA.

Keywords: PRP; hyaluronic acid; knee osteoarthritis; meta-analysis; placebo; platelet-rich plasma; steroids.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article. All authors declare no support from any organization for the submitted work. CC has received institutional support outside the present work from Medacta International SA, Johnson & Johnson, Lima Corporate, Zimmer Biomet, and Oped AG. SZ received personal fees from I+ SRL, research grants outside the submitted work from Fidia Farmaceutici SPA, CartiHeal Ltd, IGEA Clinical Biophysics, BIOMET, and Kensey Nash, and has a Springer patent with royalties paid.

Figures

Figure 1.
Figure 1.
PRISMA flowchart of the study selection process.
Figure 2.
Figure 2.
Results of the meta-analysis for the different study outcomes.

References

    1. Filardo G, Kon E, Roffi A, Di Matteo B, Merli ML, Marcacci M. Platelet-rich plasma: why intra-articular? A systematic review of preclinical studies and clinical evidence on PRP for joint degeneration. Knee Surg Sports Traumatol Arthrosc. 2015;23(9):2459-74.
    1. Gilbertie JM, Long JM, Schubert AG, Berglund AK, Schaer TP, Schnabel LV. Pooled platelet-rich plasma lysate therapy increases synoviocyte proliferation and hyaluronic acid production while protecting chondrocytes from synoviocyte-derived inflammatory mediators. Front Vet Sci. 2018;5:150.
    1. Sundman EA, Cole BJ, Karas V, Della Valle C, Tetreault MW, Mohammed HO, et al.. The anti-inflammatory and matrix restorative mechanisms of platelet-rich plasma in osteoarthritis. Am J Sports Med. 2014;42(1_suppl):35-41.
    1. Chen WH, Lin CM, Huang CF, Hsu WC, Lee CH, Ou KL, et al.. Functional recovery in osteoarthritic chondrocytes through hyaluronic acid and platelet-rich plasma-inhibited infrapatellar fat pad adipocytes. Am J Sports Med. 2016;44(10):2696-705.
    1. Gato-Calvo L, Hermida-Gomez T, Romero CR, Burguera EF, Blanco FJ. Anti-inflammatory effects of novel standardized platelet rich plasma releasates on knee osteoarthritic chondrocytes and cartilage in vitro. Curr Pharm Biotechnol. 2019;20:920-33.
    1. Mariani E, Canella V, Cattini L, Kon E, Marcacci M, Di Matteo B, et al.. Leukocyte-rich platelet-rich plasma injections do not up-modulate intra-articular pro-inflammatory cytokines in the osteoarthritic knee. PLoS One. 2016;11(6):e0156137.
    1. Mariani E, Canella V, Berlingeri A, Bielli A, Cattini L, Landini MP, et al.. Leukocyte presence does not increase microbicidal activity of platelet-rich plasma in vitro. BMC Microbiol. 2015;15:149.
    1. Foster TE, Puskas BL, Mandelbaum BR, Gerhardt MB, Rodeo SA. Platelet-rich plasma: from basic science to clinical applications. Am J Sports Med. 2009;37(11):2259-72.
    1. Kon E, Filardo G, Di Martino A, Marcacci M. Platelet-rich plasma (PRP) to treat sports injuries: evidence to support its use. Knee Surg Sports Traumatol Arthrosc. 2011;19(4):516-27.
    1. Filardo G, Kon E, Longo UG, Madry H, Marchettini P, Marmotti A, et al.. Non-surgical treatments for the management of early osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2016;24(6):1775-85.
    1. Kwon DR, Park GY, Lee SU. The effects of intra-articular platelet-rich plasma injection according to the severity of collagenase-induced knee osteoarthritis in a rabbit model. Ann Rehabil Med. 2012;36(4):458-65.
    1. Khatab S, van Buul GM, Kops N, Bastiaansen-Jenniskens YM, Bos PK, Verhaar JA, et al.. Intra-articular injections of platelet-rich plasma releasate reduce pain and synovial inflammation in a mouse model of osteoarthritis. Am J Sports Med. 2018;46(4):977-86.
    1. Di Martino A, Di Matteo B, Papio T, Tentoni F, Selleri F, Cenacchi A, et al.. Platelet-rich plasma versus hyaluronic acid injections for the treatment of knee osteoarthritis: results at 5 years of a double-blind, randomized controlled trial. Am J Sports Med. 2019;47(2):347-54.
    1. Redelmeier DA, Lorig K. Assessing the clinical importance of symptomatic improvements: an illustration in rheumatology. JAMA Intern Med. 1993;153(11):1337-42.
    1. Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264-9.
    1. Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al.. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898.
    1. Ryan R, Hill S. How to GRADE the quality of the evidence. Accessed May 15, 2020.
    1. Angst F, Aeschlimann A, Stucki G. Smallest detectable and minimal clinically important differences of rehabilitation intervention with their implications for required sample sizes using WOMAC and SF-36 quality of life measurement instruments in patients with osteoarthritis of the lower extremities. Arthritis Rheum. 2001;45(4):384-91.
    1. Saltzman BM, Leroux T, Meyer MA, Basques BA, Chahal J, Bach BR, Jr, et al.. The therapeutic effect of intra-articular normal saline injections for knee osteoarthritis: a meta-analysis of evidence level 1 studies. Am J Sports Med. 2017;45(11):2647-53.
    1. Roos EM, Lohmander LS. The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes. 2003;1(1_suppl):64.
    1. Irrgang JJ, Anderson AF, Boland AL, Harner CD, Neyret P, Richmond JC, et al.; International Knee Documentation Committee. Responsiveness of the International Knee Documentation Committee Subjective Knee Form. Am J Sports Med. 2006;34(10):1567-73.
    1. Duymus TM, Mutlu S, Dernek B, Komur B, Aydogmus S, Kesiktas FN. Choice of intra-articular injection in treatment of knee osteoarthritis: platelet-rich plasma, hyaluronic acid or ozone options. Knee Surg Sports Traumatol Arthrosc. 2017;25(2):485-92.
    1. Filardo G, Di Matteo B, Di Martino A, Merli ML, Cenacchi A, Fornasari P, et al.. Platelet-rich plasma intra-articular knee injections show no superiority versus viscosupplementation: a randomized controlled trial. Am J Sports Med. 2015;43(7):1575-82.
    1. Lin KY, Yang CC, Hsu CJ, Yeh ML, Renn JH. Intra-articular injection of platelet-rich plasma is superior to hyaluronic acid or saline solution in the treatment of mild to moderate knee osteoarthritis: a randomized, double-blind, triple-parallel, placebo-controlled clinical trial. Arthroscopy. 2019;35(1_suppl):106-17.
    1. Raeissadat SA, Rayegani SM, Hassanabadi H, Fathi M, Ghorbani E, Babaee M, et al.. Knee osteoarthritis injection choices: platelet-rich plasma (PRP) versus hyaluronic acid (a one-year randomized clinical trial). Clin Med Insights Arthritis Musculoskelet Disord. 2015;8:1-8.
    1. Huang Y, Liu X, Xu X, Liu J. Intra-articular injections of platelet-rich plasma, hyaluronic acid or corticosteroids for knee osteoarthritis. Orthopäde. 2019;48(3):239-47.
    1. Güvendi EU, Aşkin A, Güvendi G, Koçyiğit H. Comparison of efficiency between corticosteroid and platelet rich plasma injection therapies in patients with knee osteoarthritis. Arch Rheumatol. 2018;33(3):273-81.
    1. Gaballa NM, Mohammed YA, Kamel LM, Mahgoub HM. Therapeutic efficacy of intra-articular injection of platelet–rich plasma and ozone therapy in patients with primary knee osteoarthritis. Egyptian Rheumatol. 2019;41(3):183-7.
    1. Rahimzadeh P, Imani F, Faiz SHR, Entezary SR, Zamanabadi MN, Alebouyeh MR. The effects of injecting intra-articular platelet-rich plasma or prolotherapy on pain score and function in knee osteoarthritis. Clin Interv Aging. 2018;13:73-9.
    1. Bannuru RR, Schmid CH, Kent DM, Vaysbrot EE, Wong JB, McAlindon TE. Comparative effectiveness of pharmacologic interventions for knee osteoarthritis: a systematic review and network meta-analysis. Ann Intern Med. 2015;162(1_suppl):46-54.
    1. Pas HI, Winters M, Haisma HJ, Koenis MJ, Tol JL, Moen MH. Stem cell injections in knee osteoarthritis: a systematic review of the literature. Br J Sports Med. 2017;51(15):1125-33.
    1. Dai WL, Zhou AG, Zhang H, Zhang J. Efficacy of platelet-rich plasma in the treatment of knee osteoarthritis: a meta-analysis of randomized controlled trials. Arthroscopy. 2017;33(3):659-70.
    1. Kon E, Engebretsen L, Verdonk P, Nehrer S, Filardo G. Clinical outcomes of knee osteoarthritis treated with an autologous protein solution injection: a 1-year pilot double-blinded randomized controlled trial. Am J Sports Med. 2018;46(1_suppl):171-80.
    1. Previtali D, Merli G, Di Laura Frattura G, Candrian C, Zaffagnini S, Filardo G. The long-lasting effects of “placebo injections” in knee osteoarthritis: a meta-analysis. Cartilage. Epub Mar 18, 2020. doi:10.1177/1947603520906597
    1. Hohmann E, Tetsworth K, Glatt V. Is platelet-rich plasma effective for the treatment of knee osteoarthritis? A systematic review and meta-analysis of level 1 and 2 randomized controlled trials. Eur J Orthop Surg Traumatol. Epub Feb 14, 2020. doi:10.1007/s00590-020-02623-4
    1. Phillips M, Vannabouathong C, Devji T, Patel R, Gomes Z, Patel A, et al.. Differentiating factors of intra-articular injectables have a meaningful impact on knee osteoarthritis outcomes: a network meta-analysis. Knee Surg Sports Traumatol Arthrosc. Epub Jan 3, 2020. doi:10.1007/s00167-019-05763-1
    1. Chen P, Huang L, Ma Y, Zhang D, Zhang X, Zhou J, et al.. Intra-articular platelet-rich plasma injection for knee osteoarthritis: a summary of meta-analyses. J Orthop Surg Res. 2019;14(1_suppl):385.
    1. Wu Q, Luo X, Xiong Y, Liu G, Wang J, Chen X, et al.. Platelet-rich plasma versus hyaluronic acid in knee osteoarthritis: a meta-analysis with the consistent ratio of injection. J Orthop Surg (Hong Kong). 2020;28(1_suppl):2309499019887660.
    1. Han Y, Huang H, Pan J, Lin J, Zeng L, Liang G, et al.. Meta-analysis comparing platelet-rich plasma vs hyaluronic acid injection in patients with knee osteoarthritis. Pain Med. 2019;20(7):1418-29.
    1. Lieberthal J, Sambamurthy N, Scanzello CR. Inflammation in joint injury and post-traumatic osteoarthritis. Osteoarthritis Cartilage. 2015;23(11):1825-34.
    1. Lee HR, Park KM, Joung YK, Park KD, Do SH. Platelet-rich plasma loaded hydrogel scaffold enhances chondrogenic differentiation and maturation with up-regulation of CB1 and CB2. J Control Release. 2012;159(3):332-7.
    1. Kruger JP, Hondke S, Endres M, Pruss A, Siclari A, Kaps C. Human platelet-rich plasma stimulates migration and chondrogenic differentiation of human subchondral progenitor cells. J Orthop Res. 2012;30(6):845-52.
    1. Huang G, Hua S, Yang T, Ma J, Yu W, Chen X. Platelet-rich plasma shows beneficial effects for patients with knee osteoarthritis by suppressing inflammatory factors. Exp Ther Med. 2018;15(3):3096-102.
    1. Harrison P; Subcommittee on Platelet Physiology. The use of platelets in regenerative medicine and proposal for a new classification system: guidance from the SSC of the ISTH. J Thromb Haemost. 2018;16(9):1895-900.
    1. Mei-Dan O, Mann G, Maffulli N. Platelet-rich plasma: any substance into it? Br J Sports Med. 2010;44(9):618-9.
    1. Braun HJ, Kim HJ, Chu CR, Dragoo JL. The effect of platelet-rich plasma formulations and blood products on human synoviocytes: implications for intra-articular injury and therapy. Am J Sports Med. 2014;42(5):1204-10.
    1. Sundman EA, Cole BJ, Fortier LA. Growth factor and catabolic cytokine concentrations are influenced by the cellular composition of platelet-rich plasma. Am J Sports Med. 2011;39(10):2135-40.
    1. Filardo G, Kon E, Pereira Ruiz MT, Vaccaro F, Guitaldi R, Di Martino A, et al.. Platelet-rich plasma intra-articular injections for cartilage degeneration and osteoarthritis: single- versus double-spinning approach. Knee Surg Sports Traumatol Arthrosc. 2012;20(10):2082-91.
    1. Riboh JC, Saltzman BM, Yanke AB, Fortier L, Cole BJ. Effect of leukocyte concentration on the efficacy of platelet-rich plasma in the treatment of knee osteoarthritis. Am J Sports Med. 2015;44:792-800.
    1. Roffi A, Filardo G, Assirelli E, Cavallo C, Cenacchi A, Facchini A, et al.. Does platelet-rich plasma freeze-thawing influence growth factor release and their effects on chondrocytes and synoviocytes? Biomed Res Int. 2014;2014:692913.
    1. Chouhan DK, Dhillon MS, Patel S, Bansal T, Bhatia A, Kanwat H. Multiple platelet-rich plasma injections versus single platelet-rich plasma injection in early osteoarthritis of the knee: an experimental study in a Guinea pig model of early knee osteoarthritis. Am J Sports Med. 2019;47(10):2300-7.
    1. Louis ML, Magalon J, Jouve E, Bornet CE, Mattei JC, Chagnaud C, et al.. Growth factors levels determine efficacy of platelets rich plasma injection in knee osteoarthritis: a randomized double blind noninferiority trial compared with viscosupplementation. Arthroscopy. 2018;34(5):1530-40.
    1. Cole BJ, Karas V, Hussey K, Pilz K, Fortier LA. Hyaluronic acid versus platelet-rich plasma: a prospective, double-blind randomized controlled trial comparing clinical outcomes and effects on intra-articular biology for the treatment of knee osteoarthritis. Am J Sports Med. 2017;45(2):339-46.
    1. Kon E, Mandelbaum B, Buda R, Filardo G, Delcogliano M, Timoncini A, et al.. Platelet-rich plasma intra-articular injection versus hyaluronic acid viscosupplementation as treatments for cartilage pathology: from early degeneration to osteoarthritis. Arthroscopy. 2011;27(11):1490-501.
    1. O’Donnell C, Migliore E, Grandi FC, Koltsov J, Lingampalli N, Cisar C, et al.. Platelet-rich plasma (PRP) from older males with knee osteoarthritis depresses chondrocyte metabolism and upregulates inflammation. J Orthop Res. 2019;37(8):1760-70.
    1. Bennell KL, Hunter DJ, Paterson KL. Platelet-rich plasma for the management of hip and knee osteoarthritis. Curr Rheumatol Rep. 2017;19(5):24.
    1. Olsen MF, Bjerre E, Hansen MD, Tendal B, Hilden J, Hróbjartsson A. Minimum clinically important differences in chronic pain vary considerably by baseline pain and methodological factors: systematic review of empirical studies. J Clin Epidemiol. 2018;101:87-106.
    1. Johnston BC, Thorlund K, da Costa BR, Furukawa TA, Guyatt GH. New methods can extend the use of minimal important difference units in meta-analyses of continuous outcome measures. J Clin Epidemiol. 2012;65:817-26.
    1. Ahmad HS, Farrag SE, Okasha AE, Kadry AO, Ata TB, Monir AA, et al.. Clinical outcomes are associated with changes in ultrasonographic structural appearance after platelet-rich plasma treatment for knee osteoarthritis. Int J Rheum Dis. 2018;21(5):960-6.
    1. Buendía-López D, Medina-Quirós M, Fernández-Villacañas Marín MÁ. Clinical and radiographic comparison of a single LP-PRP injection, a single hyaluronic acid injection and daily NSAID administration with a 52-week follow-up: a randomized controlled trial. J Orthop Traumatol. 2018;19(1_suppl):3.
    1. Cerza F, Carnì S, Carcangiu A, Di Vavo I, Schiavilla V, Pecora A, et al.. Comparison between hyaluronic acid and platelet-rich plasma, intra-articular infiltration in the treatment of gonarthrosis. Am J Sports Med. 2012;40(12):2822-7.
    1. Elik H, Doğu B, Yılmaz F, Begoğlu FA, Kuran B. Platelet rich plasma in osteoarthritis the efficiency of platelet rich plasma treatment in patients with knee osteoarthritis. J Back Musculoskelet Rehabil. 2020;33:127-38.
    1. Forogh B, Mianehsaz E, Shoaee S, Ahadi T, Raissi GR, Sajadi S. Effect of single injection of platelet-rich plasma in comparison with corticosteroid on knee osteoarthritis: a double-blind randomized clinical trial. J Sports Med Phys Fitness. 2016;56(7-8):901-8.
    1. de Menezes Freire MR, da Silva PMC, Azevedo AR, Silva DS, da Silva RBB, Cardoso JC. Efeito comparativo entre a infiltração de plasma rico em plaquetas e o uso de corticosteroides no tratamento de osteoartrite do joelho: estudo clínico prospectivo e randomizado. Rev Bras Ortop. 2018. doi:10.1016/j.rbo.2018.01.001
    1. Ghai B, Gupta V, Jain A, Goel N, Chouhan D, Batra YK. Effectiveness of platelet rich plasma in pain management of osteoarthritis knee: double blind, randomized comparative study [in Portuguese]. Rev Bras Anestesiol. 2019;69(5):439-47.
    1. Görmeli G, Görmeli CA, Ataoglu B, Çolak C, Aslantürk O, Ertem K. Multiple PRP injections are more effective than single injections and hyaluronic acid in knees with early osteoarthritis: a randomized, double-blind, placebo-controlled trial. Knee Surg Sports Traumatol Arthrosc. 2017;25(3):958-65.
    1. Montañez-Heredia E, Irízar S, Huertas P, Otero E, del Valle M, Prat I, et al.. Intra-articular injections of platelet-rich plasma versus hyaluronic acid in the treatment of osteoarthritic knee pain: a randomized clinical trial in the context of the Spanish National Health Care System. Int J Mol Sci. 2016;17(7):E1064.
    1. Joshi Jubert N, Rodríguez L, Reverté-Vinaixa MM, Navarro A. Platelet-rich plasma injections for advanced knee osteoarthritis: a prospective, randomized, double-blinded clinical trial. Orthop J Sports Med. 2017;5(2):2325967116689386.
    1. Lana JF, Weglein A, Sampson SE, Vicente EF, Huber SC, Souza CV, et al.. Randomized controlled trial comparing hyaluronic acid, platelet-rich plasma and the combination of both in the treatment of mild and moderate osteoarthritis of the knee. J Stem Cells Regen Med. 2016;12(2):69-78.
    1. Lisi C, Perotti C, Scudeller L, Sammarchi L, Dametti F, Musella V, et al.. Treatment of knee osteoarthritis: platelet-derived growth factors vs. hyaluronic acid. A randomized controlled trial. Clin Rehabil. 2018;32(3):330-9.
    1. Nabi BN, Sedighinejad A, Mardani-Kivi M, Haghighi M, Roushan ZA, Biazar G. Comparing the effectiveness of intra-articular platelet-rich plasma and corticosteroid injection under ultrasound guidance on pain control of knee osteoarthritis. Iran Red Crescent Med J. 2018;20(3):e62157.
    1. Papalia R, Zampogna B, Russo F, Vasta S, Tirindelli M, Nobile C, et al.. Comparing hybrid hyaluronic acid with PRP in end career athletes with degenerative cartilage lesions of the knee. J Biol Regul Homeost Agents. 2016;30(4 Suppl. 1):17-23.
    1. Patel S, Dhillon MS, Aggarwal S, Marwaha N, Jain A. Treatment with platelet-rich plasma is more effective than placebo for knee osteoarthritis: a prospective, double-blind, randomized trial. Am J Sports Med. 2013;41(2):356-64.
    1. Paterson KL, Nicholls M, Bennell KL, Bates D. Intra-articular injection of photo-activated platelet-rich plasma in patients with knee osteoarthritis: a double-blind, randomized controlled pilot study. BMC Musculoskelet Disord. 2016;17(1_suppl):67.
    1. Raeissadat SA, Rayegani SM, Ahangar AG, Abadi PH, Mojgani P, Ahangar OG. Efficacy of intra-articular injection of a newly developed plasma rich in growth factor (PRGF) versus hyaluronic acid on pain and function of patients with knee osteoarthritis: a single-blinded randomized clinical trial. Clin Med Insights Arthritis Musculoskelet Disord. 2017;10:1179544117733452.
    1. Sánchez M, Fiz N, Azofra J, Usabiaga J, Recalde EA, Gutierrez AG, et al.. A randomized clinical trial evaluating plasma rich in growth factors (PRGF-Endoret) versus hyaluronic acid in the short-term treatment of symptomatic knee osteoarthritis. Arthroscopy. 2012;28(8):1070-8.
    1. Smith PA. Intra-articular autologous conditioned plasma injections provide safe and efficacious treatment for knee osteoarthritis: an FDA-sanctioned, randomized, double-blind, placebo-controlled clinical trial. Am J Sports Med. 2016;44(4):884-91.
    1. Su K, Bai Y, Wang J, Zhang H, Liu H, Ma S. Comparison of hyaluronic acid and PRP intra-articular injection with combined intra-articular and intraosseous PRP injections to treat patients with knee osteoarthritis. Clin Rheumatol. 2018;37(5):1341-50.
    1. Vaquerizo V, Plasencia MÁ, Arribas I, Seijas R, Padilla S, Orive G, et al.. Comparison of intra-articular injections of plasma rich in growth factors (PRGF-Endoret) versus durolane hyaluronic acid in the treatment of patients with symptomatic osteoarthritis: a randomized controlled trial. Arthroscopy. 2013;29(10):1635-43.
    1. Wu YT, Hsu KC, Li TY, Chang CK, Chen LC. Effects of platelet-rich plasma on pain and muscle strength in patients with knee osteoarthritis. Am J Phys Med Rehabil. 2018;97(4):248-54.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅