Comparative Clinical Effectiveness of Intra-Articular Leukocyte-Rich Platelet-Rich Plasma and Hyaluronic Acid in Treating Knee Osteoarthritis Pain: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials.

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Objective: To investigate the clinical effectiveness of intra-articular leukocyte-rich-platelet-rich plasma (LR-PRP) injections versus hyaluronic acid (HA) for pain management in patients with knee osteoarthritis (OA).Data sources: Four electronic databsases were searched, including PubMed, EMBASE, Scopus, and Web of Science. Studies included in our analysis were published between November 1, 2011, and July 14, 2023.Study selection: Randomized controlled trials (RCTs) that compared intra-articular LR-PRP versus HA injections in human adults diagnosed with knee OA.Data extraction: The Cochrane Risk of Bias Tool was used to assess the risk of bias and methodological quality of included RCTs. The mean differences (MDs) and SDs with 95% CIs were used to compare continuous outcomes, using the Review Manager 5.4 software. Two reviewers independently extracted data on patient demographics and study outcome, including Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, Visual Analog Scale scores, and adverse events.Data synthesis: Nineteen RCTs involving 1771 patients were included. LR-PRP demonstrated significant pain relief compared with HA at 3 months posttreatment, but not at 1, 6, or 12 months. At 12 months, LR-PRP was associated with improved WOMAC physical function (MD=-6.37; 95% CI, -12.51 to -0.24; I²=85%) and stiffness scores (MD=-0.63; 95% CI, -0.98 to -0.27; I²=0%), but no differences were observed at earlier timepoints or in total WOMAC scores. Adverse event rates were similar between groups.Conclusions: LR-PRP provides long-term functional improvements in patients with chronic knee OA, though evidence for short-term functional benefits remains limited. LR-PRP shows no long-term advantage over intra-articular HA injections in pain relief. Overall, the evidence does not support the superiority of LR-PRP over HA in managing knee OA.