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Platelet-Rich Plasma, Bone Marrow Aspirate Concentrate, and Hyaluronic Acid Injections Outperform Corticosteroids in Pain and Function Scores at a Minimum of 6 Months as Intra-Articular Injections for Knee Osteoarthritis: A Systematic Review and Network Meta-analysis.
Jawanda, Harkirat; Khan, Zeeshan A; Warrier, Alec A; Acuña, Alexander J; Allahabadi, Sachin; Kaplan, Daniel J; Ritz, Ethan; Jackson, Garrett R; Mameri, Enzo S; Batra, Anjay; Dornan, Grant; Westrick, Jennifer; Verma, Nikhil N; Chahla, Jorge.
Afiliação
  • Jawanda H; Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.
  • Khan ZA; Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.
  • Warrier AA; Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.
  • Acuña AJ; Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.
  • Allahabadi S; Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.
  • Kaplan DJ; Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.
  • Ritz E; Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.
  • Jackson GR; Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.
  • Mameri ES; Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.; Instituto Brasil de Tecnologia de Saude, Rio de Janeiro, Brazil; Department of Orthopedics and Traumatology, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil.
  • Batra A; Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.
  • Dornan G; Steadman Philippon Research Institute, Vail, Colorado, U.S.A.
  • Westrick J; Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.
  • Verma NN; Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.
  • Chahla J; Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.. Electronic address: Jorge.chahla@rushortho.com.
Arthroscopy ; 40(5): 1623-1636.e1, 2024 May.
Article em En | MEDLINE | ID: mdl-38331363
ABSTRACT

PURPOSE:

To compare the efficacy of common intra-articular injections used in the treatment of knee osteoarthritis, including corticosteroid (CS), hyaluronic acid (HA), platelet-rich plasma (PRP), and bone marrow aspirate concentrate (BMAC), with a minimum follow-up of 6-months.

METHODS:

A literature search was conducted using the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in August 2022 in the following databases PubMed/MEDLINE, Scopus, Cochrane Database of Controlled Trials, and the Cochrane Database of Systematic Reviews. Level I to II randomized clinical trials with a minimum follow-up of 6 months that investigated the treatments of interest were included. Patient-reported outcome scores for pain and function at baseline and at latest follow-up were extracted, and the change in scores was converted to uniform 0 to 100 scales. Arm-based Bayesian network meta-analysis using a random-effects model was created to compare the treatment arms in pain and function.

RESULTS:

Forty-eight studies comprising a total of 9,338 knees were included. The most studied intra-articular injection was HA (40.9%), followed by placebo (26.2%), PRP (21.5%), CS (8.8%), and then BMAC (2.5%). HA and PRP both led to a significant improvement in pain compared with placebo. HA, PRP, and BMAC all led to a significant improvement in function scores when compared with placebo. Surface under the cumulative ranking curves (SUCRAs) of the interventions revealed that PRP, BMAC, and HA were the treatments with the highest likelihood of improvement in both pain and function, with overall SUCRA scores of 91.54, 76.46, and 53.12, respectively. The overall SUCRA scores for CS and placebo were 15.18 and 13.70, respectively.

CONCLUSIONS:

At a minimum 6-month follow-up, PRP demonstrated significantly improved pain and function for patients with knee osteoarthritis compared with placebo. Additionally, PRP exhibited the highest SUCRA values for these outcomes when compared with BMAC, HA, and CS. LEVEL OF EVIDENCE Level II, meta-analysis of Level I to II studies.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Corticosteroides / Osteoartrite do Joelho / Plasma Rico em Plaquetas / Metanálise em Rede / Ácido Hialurônico Tipo de estudo: Clinical_trials / Guideline / Prognostic_studies / Systematic_reviews Aspecto: Patient_preference Limite: Humans Idioma: En Revista: Arthroscopy Assunto da revista: ORTOPEDIA Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Estados Unidos País de publicação: Estados Unidos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Corticosteroides / Osteoartrite do Joelho / Plasma Rico em Plaquetas / Metanálise em Rede / Ácido Hialurônico Tipo de estudo: Clinical_trials / Guideline / Prognostic_studies / Systematic_reviews Aspecto: Patient_preference Limite: Humans Idioma: En Revista: Arthroscopy Assunto da revista: ORTOPEDIA Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Estados Unidos País de publicação: Estados Unidos