• Filippo Migliorini, Arne Driessen, Valentin Quack, Nadja Sippel, Brian Cooper, MansyYasser ElYEDepartment of Orthopaedics, RWTH Aachen University Medical Centre, University Clinic Aachen, Pauwelsstraße 30, 52074, Aachen, Germany., Markus Tingart, and Jörg Eschweiler.
• Department of Orthopaedics, RWTH Aachen University Medical Centre, University Clinic Aachen, Pauwelsstraße 30, 52074, Aachen, Germany. migliorini.md@gmail.com.
• Arch Orthop Trauma Surg. 2021 Sep 1; 141 (9): 1473-1490.

IntroductionRegarding the efficacy of intra-articular injections of platelet-rich plasma, hyaluronic acid and corticosteroids, current evidence is controversial. The superiority of one technique over another is questioned and debates are ongoing. The purpose of the present study was to compare and investigate the efficacy of these intra-articular infiltrations in patients with knee osteoarthritis (OA). A Bayesian network meta-analysis of randomized clinical trials (RCTs) was conducted comparing patient outcomes at 3, 6 and 12-months of follow-up.Materials And MethodsThis Bayesian network meta-analysis was conducted according to the PRISMA extension statement for reporting systematic reviews incorporating network meta-analyses of health care interventions. All the RCTs comparing the outcomes of two or more intra-articular infiltrations of interest for knee OA were considered for inclusion. The outcomes of interest were the WOMAC and VAS scores. The network meta-analyses were performed using the STATA routine for Bayesian hierarchical random-effects models.ResultsData from 30 RCTs (3463 patients) were collected. At 3-months follow-up, PRP showed the best WOMAC scores, followed by the Placebo, CCS and HA. At 6-months follow-up, PRP showed the best WOMAC scores, followed by HA, CCS and Placebo. At 12-months follow-up, PRP showed the best WOMAC scores, followed by the Placebo, HA and CCS. At 3-months follow-up, the PRP showed the best VAS scores, followed by CCS, HA and Placebo. At 6-months follow-up, PRP showed the best VAS scores, followed by CCS, Placebo and HA. At 12-months follow-up, the PRP showed the best VAS scores, followed by CCS, Placebo and HA.ConclusionIntra-articular injections of PRP demonstrated the best overall outcome compared to steroids, hyaluronic acid and placebo for patients with knee osteoarthrosis at 3, 6 and 12-months follow-up. Among CCS, hyaluronic acid and placebo, no discrepancies were detected.Level Of EvidenceI, Bayesian network meta-analysis of RCTs.© 2020. Springer-Verlag GmbH Germany, part of Springer Nature.

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