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ORIGINAL ARTICLE
Year : 2019  |  Volume : 2  |  Issue : 4  |  Page : 159-167

Meaningful effectiveness of platelet-rich plasma in treating patients with osteoarthritis of the knee: Meta-analysis and review


1 Neuroscience Center/Physical Medicine and Department of Rehabilitation, King Fahd Specialist Hospital, Dammam, Saudi Arabia
2 Independent Scientist, New Jersey, NJ, USA
3 Pathology, Microbiology, Immunology and Forensic Medicine, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA

Correspondence Address:
Abdulhafez Selim
Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jisprm.jisprm_58_19

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Background: Osteoarthritis (OA) of the knee is a significant cause of disability. The current conservative treatment options include physiotherapy, analgesia, intra-articular injection of platelet-rich plasma (PRP), hyaluronic acid, or corticosteroids. Regarding PRP, some meta-analyses studies have been reported. However, these studies focused on the effectiveness of intra-articular PRP when compared to other controls, and none thoroughly investigated the anchored-based effectiveness concerning the minimal clinically important difference (MCID). Objective: We, therefore, conducted this work to address this apparent knowledge gap and to provide objective data that could be used by decision-makers. Methods: Electronic databases were searched to identify relevant publications. We included controlled trials that evaluated the efficacy of PRP for the treatment of OA of the knee. All included studies must have had a minimum follow-up of 24 weeks as well as pre- and post-injection Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores. Results: A total of 12 studies, involving 405 patients, were included in this analysis. The primary endpoint of this study was to compare the treatment effect measured by WOMAC scores improvement to MCID. For WOMAC score analyses, the mean difference (MD) between baseline and 6-month scores was utilized. The pooled data established significant functional improvement as demonstrated by MD of 25.5 ± 3.3 (95% confidence interval: 19.1–31.9, P< 0.001). In addition, the overall comparison of MD (25.5) to MCID (7.9) showed that the MD was approximately three-fold higher. Due to the known impact of the baseline scores on the MD, we conducted further analyses comparing MD values to the corresponding MCID for various baseline severity grades (i.e. high, intermediate, and low). The analyses showed significantly higher MD values in all categories. Conclusions: In conclusion, evidence from studies of low-to-moderate methodological quality shows that intra-articular PRP has the potential to provide a clinically meaningful symptomatic benefit for OA of the knee, at least in the short term.


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