Platelet‐Rich Plasma Combined With Hyaluronic Acid Improves Pain and Function Compared With Hyaluronic Acid Alone in Knee Osteoarthritis: A Systematic Review and Meta‐analysis
Bibliographic record
Abstract
Purpose To evaluate the efficacy of platelet‐rich plasma (PRP) combined with hyaluronic acid (HA) injections versus HA injections alone for the management of knee osteoarthritis (OA). Methods This study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Eligible randomized‐controlled trials and observational studies directly comparing combined PRP‐HA injections with HA injections alone were identified through a search of PubMed, Scopus, and Cochrane Central databases from inception to May 2020. A random effects model meta‐analysis was conducted and the I 2 statistic was used to assess for heterogeneity. Results Four studies comprising 377 patients (PRP‐HA: 193, HA: 184) with knee OA ranging from I‐IV Kellgren–Lawrence grading scale were included. The final follow‐up was 12 months in 3 studies and 6 months in 1 study. Patients who received PRP combined with HA had significantly greater improvements compared with those injected with HA alone in terms of visual analog scale scores at 3‐month (standardized mean difference [SMD] 1.13; 95% confidence interval [CI] 0.56‐1.70; I 2 = 56.7%; P < .001), 6‐month (SMD 1.08; 95% CI 0.54‐1.62; I 2 = 67.9%; P < .001), and 12‐month (SMD 1.13; 95% CI 0.74‐1.52; I 2 = 0.0%; P < .001) and 12‐month Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical functioning (SMD 0.91; 95% CI 0.65‐1.17; I 2 = 0.0%; P < .001) and 12‐month WOMAC stiffness (SMD 1.09; 95% CI 0.80‐1.38; I 2 = 0.0%; P < .001) scores. No difference was identified in terms of 12‐month WOMAC pain score (SMD 0.36; 95% CI –0.19 to 0.91; I 2 = 74.1%; P = .195). Conclusions Symptomatic patients with knee OA who were injected with a combination of PRP and HA demonstrated greater improvement in pain and function compared with patients who received HA injections only, as assessed by 3‐, 6‐, and 12‐month visual analog scale scores and 12‐month WOMAC physical function and stiffness scores. This study provides encouraging evidence for the use of the combined PRP‐HA injections in the management of symptomatic patients with knee OA. Level of Evidence III (meta‐analysis of randomized and non‐randomized comparative trials).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.013 | 0.025 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.023 | 0.040 |
| Bibliometrics | 0.005 | 0.005 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".