PMID- 32278352 OWN - NLM STAT- MEDLINE DCOM- 20210107 LR - 20210107 IS - 1471-2474 (Electronic) IS - 1471-2474 (Linking) VI - 21 IP - 1 DP - 2020 Apr 11 TI - Effects and safety of the combination of platelet-rich plasma (PRP) and hyaluronic acid (HA) in the treatment of knee osteoarthritis: a systematic review and meta-analysis. PG - 224 LID - 10.1186/s12891-020-03262-w [doi] LID - 224 AB - BACKGROUND: Studies have shown that the combined application of hyaluronic acid (HA) and platelet-rich plasma (PRP) can repair degenerated cartilage and delay the progression of knee osteoarthritis (KOA). The purpose of this study was to explore the efficacy and safety of the intra-articular injection of PRP combined with HA compared with the intra-articular injection of PRP or HA alone in the treatment of KOA. METHODS: The PubMed, Cochrane Library, EMBASE and China National Knowledge Infrastructure (CNKI) databases were searched from inception to December 2019. Randomized controlled trials and cohort studies of PRP combined with HA for KOA were included. Two orthopaedic surgeons conducted the literature retrieval and extracted the data. Outcome indicators included the Western Ontario and McMaster Universities Arthritis Index (WOMAC), the Lequesne Index, the visual analogue scale (VAS) for pain, and adverse events (AEs). Review Manager 5.3 was used to calculate the relative risk (RR) or standardized mean difference (SMD) of the pooled data. STATA 14.0 was used for quantitative publication bias evaluation. RESULTS: Seven studies (5 randomized controlled trials, 2 cohort studies) with a total of 941 patients were included. In the VAS comparison after 6 months of follow-up, PRP combined with HA was more likely to reduce knee pain than PRP alone (SMD: - 0.31; 95% confidence interval (CI): - 0.55 to - 0.06; P = 0.01 < 0.05). PRP combined with HA for KOA achieved better improvements in the WOMAC Function Score (SMD: -0.32; 95% CI: - 0.54 to - 0.10; P < 0.05) and WOMAC Total Score (SMD: -0.42; 95% CI: - 0.67 to - 0.17; P < 0.05) at the 12-month follow-up than did the application of PRP alone. In a comparison of Lequesne Index scores at the 6-month follow-up, PRP combined with HA improved knee pain scores more than PRP alone (SMD: -0.42; 95% CI: - 0.67 to - 0.17; P < 0.05). In terms of AEs, PRP combined with HA was not significantly different from PRP or HA alone (P > 0.05). CONCLUSIONS: Compared with intra-articular injection of PRP alone, that of PRP combined with HA can improve the WOMAC Function Scores, WOMAC Total Score, 6-month follow-up VAS ratings, and Lequesne Index scores. However, in terms of the incidence of AEs, PRP combined with HA is not significantly different from PRP or HA alone. FAU - Zhao, Jinlong AU - Zhao J AUID- ORCID: 0000-0001-7079-1336 AD - The Second School of clinical medical Sciences, Guangzhou University of Chinese Medicine, Guagnzhou, 510405, China. AD - Guangdong Academy of Traditional Chinese Medicine, Research Team on Bone and Joint Degeneration and Injury, Guangzhou, 510120, China. FAU - Huang, Hetao AU - Huang H AUID- ORCID: 0000-0002-6197-1375 AD - The Second School of clinical medical Sciences, Guangzhou University of Chinese Medicine, Guagnzhou, 510405, China. AD - Guangdong Academy of Traditional Chinese Medicine, Research Team on Bone and Joint Degeneration and Injury, Guangzhou, 510120, China. FAU - Liang, Guihong AU - Liang G AUID- ORCID: 0000-0002-7599-2628 AD - The Second School of clinical medical Sciences, Guangzhou University of Chinese Medicine, Guagnzhou, 510405, China. AD - Guangdong Academy of Traditional Chinese Medicine, Research Team on Bone and Joint Degeneration and Injury, Guangzhou, 510120, China. FAU - Zeng, Ling-Feng AU - Zeng LF AUID- ORCID: 0000-0003-1311-8641 AD - The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, 510120, China. AD - Guangdong Academy of Traditional Chinese Medicine, Research Team on Bone and Joint Degeneration and Injury, Guangzhou, 510120, China. FAU - Yang, Weiyi AU - Yang W AUID- ORCID: 0000-0001-8657-2269 AD - The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, 510120, China. AD - Guangdong Academy of Traditional Chinese Medicine, Research Team on Bone and Joint Degeneration and Injury, Guangzhou, 510120, China. FAU - Liu, Jun AU - Liu J AUID- ORCID: 0000-0002-1943-3880 AD - The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, 510120, China. liujun.gdtcm@hotmail.com. AD - Guangdong Academy of Traditional Chinese Medicine, Research Team on Bone and Joint Degeneration and Injury, Guangzhou, 510120, China. liujun.gdtcm@hotmail.com. LA - eng GR - No.[2014]157, No.[2018]8/Project of Guangdong Provincial Department of Finance/ GR - No. 2018M633036/Postdoctoral Research Foundation of China/ GR - No. B2019091/Medical Science and Technology Foundation of Guangdong Province/ GR - No.81873314, No.81974574, No. 81473698/the National Natural Science Foundation of China/ GR - No. 2018KQNCX041/Key scientific research platforms and research projects of universities in Guangdong Province/ GR - No.YN2019ML08, No. YK2013B2N19, YN2015MS15/the Science and Technology Research Project of Guangdong Provincial Hospital of Chinese Medicine/ PT - Journal Article PT - Meta-Analysis PT - Systematic Review DEP - 20200411 PL - England TA - BMC Musculoskelet Disord JT - BMC musculoskeletal disorders JID - 100968565 RN - 0 (Viscosupplements) RN - 9004-61-9 (Hyaluronic Acid) SB - IM MH - Combined Modality Therapy MH - Humans MH - Hyaluronic Acid/adverse effects/*therapeutic use MH - Injections, Intra-Articular MH - Osteoarthritis, Knee/*therapy MH - Pain Measurement MH - *Platelet-Rich Plasma MH - Randomized Controlled Trials as Topic MH - Treatment Outcome MH - Viscosupplements/adverse effects/*therapeutic use PMC - PMC7149899 OTO - NOTNLM OT - Hyaluronic acid OT - Knee osteoarthritis OT - Meta-analysis OT - Platelet-rich plasma COIS- The authors declare that they have no competing interests. EDAT- 2020/04/13 06:00 MHDA- 2021/01/08 06:00 PMCR- 2020/04/11 CRDT- 2020/04/13 06:00 PHST- 2020/01/30 00:00 [received] PHST- 2020/04/02 00:00 [accepted] PHST- 2020/04/13 06:00 [entrez] PHST- 2020/04/13 06:00 [pubmed] PHST- 2021/01/08 06:00 [medline] PHST- 2020/04/11 00:00 [pmc-release] AID - 10.1186/s12891-020-03262-w [pii] AID - 3262 [pii] AID - 10.1186/s12891-020-03262-w [doi] PST - epublish SO - BMC Musculoskelet Disord. 2020 Apr 11;21(1):224. doi: 10.1186/s12891-020-03262-w.