Background
Methods
Inclusion and exclusion criteria
Primary and secondary outcomes
Search strategy
Data extraction
Quality assessment
Data analysis
Results
Study characteristics
Studies | Country | Sample size | Age (years) Mean ± SD | % female | Body mass index (kg/m2) | Outcome measurement | Follow-up | Dropout | Risk of bias | Conclusiona
|
---|---|---|---|---|---|---|---|---|---|---|
Cerza et al.[9] | Single centre Italy | PRP 60 HA 60 | PRP 66.5 ± 11.3 HA 66.2 ± 10.6 | PRP 58% HA 53% | NR | WOMAC total scores, adverse events | 4, 12, 24 weeks | PRP 0 HA 0 | High | + |
Duymus et al.[29] | Single centre Turkey | PRP 41 HA 40 Ozone 39 | PRP 60.4 ± 5.1 HA 60.3 ± 9.1 Ozone 59.4 ± 5.7 | PRP 97% HA 97.1% Ozone 88.6% | PRP 27.6 ± 4.6 HA 28.4 ± 3.6 Ozone 27.6 ± 4.4 | VAS, WOMAC scores | 1, 3, 6, 12 months | PRP 8 HA 6 Ozone 4 | High | + |
Filardo et al.[17] | Single centre Italy | PRP 96 HA 96 | PRP 53.3 ± 13.2 HA 57.6 ± 11.8 | PRP 36.2% HA 41.6% | PRP 26.6 ± 4.0 HA 26.9 ± 4.4 | IKDC subjective, KOOS, EQ-VAS, Tegner score, ROM, Transpatellar circumference, patient satisfaction, adverse events | 2, 6, 12 months | PRP 2 HA 7 | Moderate | – |
Forogh et al.[30] | Single centre Iran | 41 in totalb
| PRP 59.1 ± 7.0 CS 61.1 ± 6.7 | PRP 70.8% CS 62.5% | PRP 28.9 ± 2.8 CS 29.2 ± 3.4 | KOOS, VAS, ROM, 20 meters walk test, patient satisfaction | 2, 6 months | PRP 1 CS 6 | High | + |
Görmeli et al.[31] | Single centre Turkey | PRP 46 PRP/S 45 HA 46 Placebo 45 | PRP 53.7 ± 13.1 PRP/S 53.8 ± 13.4 HA 53.5 ± 14 Placebo 52.8 ± 12.8 | PRP 58.9% PRP/S 56.8% HA 56.4% Placebo 50% | PRP 28.7 ± 4.8 PRP/S 28.4 ± 4.4 HA 29.7 ± 3.7 Placebo 29.5 ± 3.2 | EQ-VAS, IKDC subjective, patient satisfaction | 6 months | PRP 7 PRP/S 1 HA 7 Placebo 5 | High | + |
Li et al.[10] | Single centre China | PRP 15 HA 15 | PRP 57.6 HA 58.2 | PRP 60% HA 53.3% | PRP 24.3 HA 24 | IKDC, WOMAC total score, Lequesne index, adverse events | 3, 4, 6 months | PRP 0 HA 0 | High | + |
Montañez-Heredia et al.[35] | Single centre Spain | PRP 28 HA 27 | PRP 66.3 ± 8.3 HA 61.5 ± 8.6 | PRP 55.6% HA 65.4% | PRP 29.0 ± 5.5 HA 30.4 ± 4.9 | VAS, KOOS, EUROQOL, adverse events | 3, 6 months | PRP 1 HA 1 | High | + |
Patel et al.[11] | Single centre India | PRP1 27 PRP2 25 Placebo 26 | PRP1 53.1 ± 11.6 PRP2 51.6 ± 9.2 Placebo 53.7 ± 8.2 | PRP1 59% PRP2 80% Placebo 73.9% | PRP1 25.8 ± 3.3 PRP2 25.8 ± 3.3 Placebo 26.2 ± 2.9 | WOMAC score, VAS, patient satisfaction, adverse events | 6 weeks, 3, 6 months | PRP1 1 PRP2 0 Placebo 3 | High | + |
Paterson et al.[32] | Single centre Australia | PRP 12 HA 11 | PRP 49.9 ± 13.7 HA 52.7 ± 10.3 | PRP 27.3% HA 30% | PRP 27.9 ± 11.9 HA 30.9 ± 5.6 | VAS, KOOS, KQoL, Functional tests, adverse events | 4, 12 weeks | PRP 2 HA 2 | Moderate | – |
Raeissadat et al.[33] | Single centre Iran | PRP 87 HA 73 | PRP 56.9 ± 9.1 HA 61.1 ± 7.5 | PRP 89.6% HA 75.8% | PRP 28.2 ± 4.6 HA 27.0 ± 4.2 | WOMAC total score, SF-36 | 52 weeks | PRP 10 HA 11 | High | + |
Sánchez et al.[13] | Multi-centre Spain | PRP 89 HA 87 | PRP 60.5 ± 7.9 HA 58.9 ± 8.2 | PRP 52% HA 52% | PRP 27.9 ± 2.9 HA 28.2 ± 2.7 | Normalized WOMAC score, Lequesne index, adverse events | 6 months | PRP 10 HA 13 | Moderate | + |
Smith et al.[34] | Single centre USA | PRP 15 Placebo 15 | PRP 53.5 ± 8.2 Placebo 46.6 ± 9.4 | PRP 66.7% Placebo 60% | PRP 29.5 ± 6.9 Placebo 27.5 ± 4.8 | WOMAC score, adverse events | 1, 2 weeks, 2, 3, 6, 12 months | PRP 0 Placebo 0 | Moderate | + |
Spaková et al.[14] | Single centre Slovakia | PRP 60 HA 60 | PRP 52.8 ± 12.4 HA 53.2 ± 14.5 | PRP 45% HA 48.3% | PRP 27.9 ± 4.1 HA 28.3 ± 4.0 | WOMAC total score, NRS, adverse events | 3, 6 months | PRP 0 HA 0 | High | + |
Vaquerizo et al.[15] | Multi-centre Spain | PRP 48 HA 48 | PRP 62.4 ± 6.6 HA 64.8 ± 7.7 | PRP 66.7% HA 54.2% | PRP 30.7 ± 3.6 HA 31.0 ± 4.6 | WOMAC score, Lequesne index, adverse events | 24, 48 weeks | PRP 0 HA 6 | High | + |
PRP | Control | |||||||
---|---|---|---|---|---|---|---|---|
Studies | Categorya
| Preparation | Spinning | Activation | Injection dose, times, and intervals | Fresh/ frozen | Type | Injection dose, times, and intervals |
Cerza et al.[9] | LP-PRP | ACP | Single | NR | 5.5 mL, 4 times, weekly | Fresh | Hyalgan, | 20 mg, 4 times, weekly |
Duymus et al.[29] | LR-PRP | Ycellbio kit | Single | No | 5 mL, 2 times, monthly | Fresh | Ostensil Plus, Ozone gas | 40 mg, 1 time; 15 mL, 4 times, weekly |
Filardo et al.[17] | LR-PRP | Custom | Double | CaCl2
| 5 mL, 3 times, weekly | Frozen | Hyalubrix, | 30 mg, 3 times, weekly |
Forogh et al.[30] | LR-PRPb
| TUBEX kit | Double | CaCl2
| 5 mL, 1 time | Fresh | Depo Medrol | 40 mg, 1 time |
Görmeli et al.[31]c
| LR-PRP | Custom | Double | CaCl2
| 5 mL, 3 times, weekly | 1Fresh/ 2Frozen | Orthovisc, Saline | 30 mg, 3 times, weekly; NR, 3 times, weekly |
Li et al.[10] | LR-PRP | Weigao kit | Double | CaCl2
| 3.5 mL, 3 times, 3 weeks | Fresh | Sofast | 2 mL, 3 times, 3 weeks |
Montañez-Heredia et al.[35] | LP-PRP | Custom | Double | NR | NR, 3 times, 15 days | Frozen | Adant | NR, 3 times, 15 days |
Patel et al.[11]c
| LP-PRP | Custom | Single | CaCl2
| 8 mL, 2 times, 3 weeks | Fresh | Saline | 8 mL, 1 time |
Paterson et al.[32] | LR-PRP | Custom | Double | Ultraviolet | 3 mL, 3 times, weekly | Fresh | Hylan G-F 20 | 3 mL, 3 times, weekly |
Raeissadat et al.[33] | LR-PRP | Rooyagen kit | Double | No | 4-6 mL, 2 times, 4 weeks | Fresh | Hyalgan | 20 mg, 3 times, weekly |
Sánchez et al.[13] | LP-PRP | PRGF-Endoret | Single | CaCl2
| 8 mL, 3 times, weekly | Fresh | Euflexxa | NR, 3 times, weekly |
Smith et al.[34] | LP-PRP | ACP | Single | NR | 3-8 mL, 3 times, weekly | Fresh | Saline | 3-8 mL, 3 times, weekly |
Spaková et al.[14] | LR-PRP | Custom | Triple | No | 3 mL, 3 times, weekly | Fresh | Erectus | NR, 3 times, weekly |
Vaquerizo et al.[15] | LP-PRP | PRGF-Endoret | Single | CaCl2
| 8 mL, 3 times, weekly | Fresh | Durolane | NR, 1 time |
Studies | Intervention | Kellgren Lawrence | Ahlbäck | ||||||
---|---|---|---|---|---|---|---|---|---|
0 | I | II | III | IV | I | II | III | ||
Cerza et al.[9] | PRP | 21 | 24 | 15 | |||||
HA | 25 | 22 | 13 | ||||||
Duymus et al.[29] | PRP | 22 | 11 | ||||||
HA | 24 | 10 | |||||||
Ozone | 23 | 12 | |||||||
Filardo et al.[17] | PRP | 0–IV, Mean ± SD: 2.0 ± 1.1 | |||||||
HA | 0–IV, Mean ± SD: 2.0 ± 1.1 | ||||||||
Forogh et al.[30]a
| PRP | 7 | 17 | ||||||
CS | 8 | 16 | |||||||
Görmeli et al.[31] | PRP | I–III, 26 | 13 | ||||||
PRP/S HA | I–III, 30 I–III, 25 | 14 14 | |||||||
Placebo | I–III, 27 | 13 | |||||||
Li et al.[10] | PRP | 6 | 2 | 4 | 3 | ||||
HA | 6 | 3 | 3 | 3 | |||||
Montañez-Heredia et al.[35] | PRP | 5 | 10 | 12 | |||||
HA | 2 | 9 | 15 | ||||||
Patel et al.[11] a
| PRP1
PRP2
| 37 36 | 11 10 | 2 2 | |||||
Placebo | 25 | 18 | 3 | ||||||
Paterson et al.[32] | PRP | II–III, 12 | |||||||
HA | II–III, 11 | ||||||||
Raeissadat et al.[33] | PRP | 5 | 34 | 29 | 9 | ||||
HA | 0 | 29 | 23 | 10 | |||||
Sánchez et al.[13] | PRP | 45 | 32 | 12 | |||||
HA | 42 | 32 | 11 | ||||||
Smith et al.[34] | PRP | 8 | 7 | ||||||
Placebo | 10 | 5 | |||||||
Spaková et al.[14] | PRP | 2 | 39 | 19 | |||||
HA | 2 | 37 | 21 | ||||||
Vaquerizo et al.[15] | PRP | 14 | 26 | 8 | |||||
HA | 18 | 21 | 9 |