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The role of intra-articular platelet-rich plasma (PRP) injections in symptomatic knee osteoarthritis conservative treatment - A systematic review
ESSKA Academy. Figueiredo Pais N. May 11, 2018; 218121
Nuno Gonçalo Figueiredo Pais
Nuno Gonçalo Figueiredo Pais
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Abstract
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Objectives: In the last 5 years several randomized controlled trials (RCT) were published assessing platelet-rich plasma (PRP) efficacy in symptomatic knee osteoarthritis conservative treatment.
This systematic review aims to present current state of art of PRP role in symptomatic knee osteoarthritis management.

Methods: A systematic literature search of level I randomized controlled trials comparing knee PRP injections efficacy, duration of action and safety profile was conducted by two independent researchers in PubMed, Embase, Scopus, and the Cochrane database through August 2017. We used as keywords "platelet-rich plasma", "PRP", "cartilage" e "knee osteoarthritis"; using Boolean operators (AND) and (OR).
Inclusion criteria: (1) study assessing PRP efficacy and/or safety profile in knee osteoarthritis treatment; (2) randomized controlled trials (RCT); (3) human studies; (4) articles written in English or Portuguese language
Exclusion criteria: (i) non-direct comparison between PRP and other knee intraarticular treatment; (ii) PRP studies in focal cartilage defects; (iii) systematic reviews or meta-analysis; (iv) clinical commentary or expert opinions; (v) case reports; (vi) animal studies
Methodological quality of all trials included was analyzed, as well as a summary description of clinical results.

Results: Seventeen RCT were included, in a total of 1733 patients. Control groups included were: hyaluronic acid, corticosteroids, saline solution, local anesthetic and ozone therapy.

Follow-up period varied between 12 weeks and 24 months. Bias risk assessment evidenced that only 4 of 17 studies included showed moderate bias risk, being the remaining considered of high bias risk.
With exception of 2 studies, in all remaining PRP injections were more effective in pain reduction (VAS, KOOS-pain subscale and WOMAC pain score) and function improvement (KOOS-function subscale, WOMAC physical function and IKDC) until 12 months, being verified a gradual clinical effect decrease from this point, comparatively with control group.
There were not related relevant adverse effects. Incidence of post-injection pain was not different relatively to control group.

Conclusions: Current evidence available points for positive and superior clinical effects in knee pain relief and mechanical knee function, relatively to hyaluronic acid, corticosteroids, local anesthetics and ozone injections therapy in the treatment of symptomatic knee osteoarthritis until 1 year after PRP knee injection.
Well-designed and methodological robust RCT with low bias risk are needed with large populations in order to clarify PRP knee injections role in conservative symptomatic knee osteoarthritis treatment.

Keywords:
platelet-rich plasma, PRP, osteoarthritis, knee, growth factors, intra-articular injections, cartilage
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