PMID- 38294103
OWN - NLM
STAT- MEDLINE
DCOM- 20240214
LR  - 20240214
IS  - 1433-7347 (Electronic)
IS  - 0942-2056 (Linking)
VI  - 32
IP  - 2
DP  - 2024 Feb
TI  - Intra-articular corticosteroid injections provide a clinically relevant benefit 
      compared to placebo only at short-term follow-up in patients with knee 
      osteoarthritis: A systematic review and meta-analysis.
PG  - 311-322
LID - 10.1002/ksa.12057 [doi]
AB  - PURPOSE: To quantify the clinical relevance of intra-articular corticosteroid 
      effects compared to placebo for the injective treatment of knee osteoarthritis 
      (OA). METHODS: The PubMed, Cochrane Library and Web of Science databases were 
      searched on May 3, 2023. This study was conducted in accordance with the PRISMA 
      guidelines. The inclusion criteria were randomized controlled trials (RCTs), 
      published in English, with no time limitation regarding publication date, 
      comparing intra-articular corticosteroids and placebo injections for knee OA. The 
      effects were quantified at short- (</=6 weeks), mid- (>6 weeks and </=3 months), and 
      long-term (>/=6 months) follow-ups. The minimal clinically important difference 
      (MCID) for the outcomes (visual analogue scale for pain - VAS: 1.4, Western 
      Ontario and McMaster University Osteoarthritis Index - WOMAC: 9) was used to 
      interpret the clinical improvement provided by intra-articular corticosteroid 
      injections compared to placebo. The quality of each article was assessed using 
      the Cochrane RoB 2 tool and the GRADE guidelines. RESULTS: Among the 1030 
      articles retrieved, 11 RCTs (842 patients) were included. A comparison of the two 
      groups revealed statistically significant differences in the improvement of VAS 
      and WOMAC scores in terms of the mean difference (MD); this difference was in 
      favour of corticosteroids at short-term (p < 0.001, MD = -1.6 and p < 0.001, 
      MD = -9.9, respectively) and mid-term follow-ups (p = 0.001, mean MD = -1.3 and 
      p = 0.005, MD = -4.9, respectively). No difference was observed at the long-term 
      follow-up. The MDs between the improvements in the two groups reached the MCID 
      values for the VAS and WOMAC only at the short-term follow-up. The RoB 2 tool and 
      the GRADE evaluations showed the presence of risk of bias and limited quality of 
      evidence. CONCLUSION: This systematic review and meta-analysis demonstrated that 
      intra-articular corticosteroid injections offer clinically perceivable pain 
      relief and functional improvement higher than the placebo effect only at 
      short-term follow-up in patients affected by knee OA, with benefits losing 
      clinical relevance already after 6 weeks. These results, together with the low 
      number and the limited quality of the RCTs comparing this treatment with placebo, 
      question the indication for the use of corticosteroid injections in clinical 
      practice for the treatment of knee OA. LEVEL OF EVIDENCE: Level I.
CI  - (c) 2024 European Society of Sports Traumatology, Knee Surgery and Arthroscopy.
FAU - Bensa, Alessandro
AU  - Bensa A
AUID- ORCID: 0000-0002-1021-063X
AD  - Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, 
      Switzerland.
FAU - Albanese, Jacopo
AU  - Albanese J
AD  - Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, 
      Switzerland.
FAU - Boffa, Angelo
AU  - Boffa A
AD  - Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, 
      Bologna, Italy.
FAU - Previtali, Davide
AU  - Previtali D
AD  - Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, 
      Switzerland.
FAU - Filardo, Giuseppe
AU  - Filardo G
AD  - Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, 
      Switzerland.
AD  - Applied and Translational Research (ATR) Center, IRCCS Istituto Ortopedico 
      Rizzoli, Bologna, Italy.
AD  - Faculty of Biomedical Sciences, Universita della Svizzera Italiana, Lugano, 
      Switzerland.
LA  - eng
GR  - None/
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20240131
PL  - Germany
TA  - Knee Surg Sports Traumatol Arthrosc
JT  - Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA
JID - 9314730
RN  - 0 (Adrenal Cortex Hormones)
RN  - 9004-61-9 (Hyaluronic Acid)
SB  - IM
MH  - Humans
MH  - *Osteoarthritis, Knee
MH  - Follow-Up Studies
MH  - Injections, Intra-Articular
MH  - Adrenal Cortex Hormones/therapeutic use
MH  - Pain
MH  - Treatment Outcome
MH  - Hyaluronic Acid/therapeutic use
OTO - NOTNLM
OT  - corticosteroids
OT  - injections
OT  - intra-articular
OT  - knee
OT  - osteoarthritis
OT  - placebo
EDAT- 2024/01/31 12:42
MHDA- 2024/02/11 16:42
CRDT- 2024/01/31 08:06
PHST- 2023/12/28 00:00 [revised]
PHST- 2023/10/13 00:00 [received]
PHST- 2024/01/02 00:00 [accepted]
PHST- 2024/02/11 16:42 [medline]
PHST- 2024/01/31 12:42 [pubmed]
PHST- 2024/01/31 08:06 [entrez]
AID - 10.1002/ksa.12057 [doi]
PST - ppublish
SO  - Knee Surg Sports Traumatol Arthrosc. 2024 Feb;32(2):311-322. doi: 
      10.1002/ksa.12057. Epub 2024 Jan 31.