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Comparison of the clinical effectiveness of activated and non-activated platelet-rich plasma in the treatment of knee osteoarthritis: a systematic review and meta-analysis

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Abstract

Introduction/objectives

Platelet-rich plasma (PRP) has shown to be clinically effective in the treatment of knee osteoarthritis (OA). Notwithstanding, some inconsistences remain due to methodological differences in PRP preparation such as the use (or not) of activation strategies. We aimed to evaluate whether the use of non-activated PRP would be as effective as activated PRP in patients with knee OA.

Method

All randomized, placebo-controlled trials were identified through a search in MEDLINE, EMBASE, Scopus, and Web of Science up to June 2022. Pre- and post-injection pain and function scores were collected. The meta-analysis was conducted with a random-effects model and generic inverse variance method. Effect sizes were estimated using standardized mean differences (SMD).

Results

Fourteen clinical trials involving 1292 subjects were included for meta-analysis. Exogenous activation of PRP revealed a significant pain relief (SMD, − 1.05 [95% CI − 1.58 to − 0.52]; p = 0.0001) and a significant functional improvement (SMD, − 1.21 [95% CI − 1.75 to − 0.67]; p < 0.0001) unlike studies describing the use of a non-activated PRP. The sensitivity analysis indicated that the effect size for both outcomes was not influenced by a single study.

Conclusions

The results of this systematic review suggest that the use of an exogenously activated PRP is more effective in improving both pain and functional scores in patients with knee OA.

Key Points

• Results from meta-analysis suggest that exogenously activated PRP is clinically more effective than non-activated PRP.

• The use of an activated PRP was more frequently reported by the included studies.

• The most frequent method for activation was the use of calcium chloride (CaCl 2 ).

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Authors and Affiliations

  1. Orthopedic Trauma Service, School of Medicine and University Hospital “Dr. José Eleuterio González”, Universidad Autonoma de Nuevo Leon, Ave. Francisco I. Madero and Ave. Dr. José Eleuterio González, Monterrey, Nuevo León, México

    Mario Simental-Mendía, Daniela Ortega-Mata, Yadira Tamez-Mata, Carlos A. Acosta Olivo & Félix Vilchez-Cavazos

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  1. Mario Simental-Mendía
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  2. Daniela Ortega-Mata
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Correspondence to Félix Vilchez-Cavazos.

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Electronic supplementary material

Appendix 1. Search strategies used for the identification of potential records of interest in the different databases.

Appendix 1. Search strategies used for the identification of potential records of interest in the different databases.

Embase / Ovid MEDLINE(R)

  1. 1

    exp knee osteoarthritis

  2. 2

    exp thrombocyte rich plasma

  3. 3

    ("nonactivated " or "Non-activated" or "no activated" or "non-activated PRP" or "activated-PRP" or "non-active" or "reactivity" or "activ*").mp. [mp = ti, ab, hw, tn, ot, dm, mf, dv, kf, fx, dq, nm, ox, px, rx, an, ui, sy]

  4. 4

    exp intraarticular drug administration

  5. 5

    ("intra-articular injection" or "intra articular injections" or "intraarticular Injections" or "intra-articular PRP injection" or "intra-articular platelet-rich plasma injection" or "Intra-articular Autologous Conditioned Plasma Injections" or "intra-articular (IA) injection").mp. [mp = ti, ab, hw, tn, ot, dm, mf, dv, kf, fx, dq, nm, ox, px, rx, an, ui, sy]

  6. 6

    4 or 5

  7. 7

    ("Knee Osteoarthritides" or "Osteoarthritis, Knee" or "Knee Osteoarthritis" or "Osteoarthritis of Knee" or "Osteoarthritis of the Knee").mp. [mp = ti, ab, hw, tn, ot, dm, mf, dv, kf, fx, dq, nm, ox, px, rx, an, ui, sy]

  8. 8

    1 or 7

  9. 9

    ("platelet-rich plasma" or "Plasma, Platelet-Rich" or "Platelet Rich Plasma" or "PRP" or "platelets").mp. [mp = ti, ab, hw, tn, ot, dm, mf, dv, kf, fx, dq, nm, ox, px, rx, an, ui, sy]

  10. 10

    2 or 9

  11. 11

    6 and 8 and 10

  12. 12

    3 and 11

Scopus

( "Knee Osteoarthritides" OR "Osteoarthritis, Knee" OR "Knee Osteoarthritis" OR "Osteoarthritis of Knee" OR "Osteoarthritis of the Knee") AND ( "platelet-rich plasma" OR "Plasma, Platelet-Rich" OR "Platelet Rich Plasma" OR "PRP" OR "platelets") AND ( "nonactivated " OR "Non-activated" OR "no activated" OR "non-activated PRP" OR "activated-PRP" OR "non-active" OR "reactivity" OR "activ*") AND ( "intra-articular injection" OR "intra articular injections" OR "intraarticular Injections" OR "intra-articular PRP injection" OR "intra-articular platelet-rich plasma injection" OR "Intra-articular Autologous Conditioned Plasma Injections" OR "intra-articular (IA) injection").

Web of Science

1"Knee Osteoarthritides" OR "Osteoarthritis, Knee" OR "Knee Osteoarthritis" OR "Osteoarthritis of Knee" OR "Osteoarthritis of the Knee".

2"platelet-rich plasma" OR "Plasma, Platelet-Rich" OR "Platelet Rich Plasma" OR "PRP" OR "platelets".

3"nonactivated " OR "Non-activated" OR "no activated" OR "non-activated PRP" OR "activated-PRP" OR "non-active" OR "reactivity" OR "activ*".

4"intra-articular injection" OR "intra articular injections" OR "intraarticular Injections" OR "intra-articular PRP injection" OR "intra-articular platelet-rich plasma injection" OR "Intra-articular Autologous Conditioned Plasma Injections" OR "intra-articular (IA) injection".

5. (((#1) AND #2) AND #3) AND #4

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Simental-Mendía, M., Ortega-Mata, D., Tamez-Mata, Y. et al. Comparison of the clinical effectiveness of activated and non-activated platelet-rich plasma in the treatment of knee osteoarthritis: a systematic review and meta-analysis. Clin Rheumatol 42, 1397–1408 (2023). https://doi.org/10.1007/s10067-022-06463-x

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