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The use of platelet-rich plasma in studies with early knee osteoarthritis versus advanced stages of the disease: a systematic review and meta-analysis of 31 randomized clinical trials
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  • Félix Vilchez-Cavazos,
  • Jaime Blázquez-Saldaña,
  • Augusto Gamboa-Alonso,
  • Víctor Peña-Martínez,
  • Carlos Acosta-Olivo,
  • Adriana Sánchez-García,
  • Mario Simental-Mendía
Félix Vilchez-Cavazos
Universidad Autonoma de Nuevo Leon
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Jaime Blázquez-Saldaña
Universidad Autonoma de Nuevo Leon
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Augusto Gamboa-Alonso
Universidad Autonoma de Nuevo Leon
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Víctor Peña-Martínez
Universidad Autonoma de Nuevo Leon
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Carlos Acosta-Olivo
Universidad Autonoma de Nuevo Leon
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Adriana Sánchez-García
Universidad Autonoma de Nuevo Leon
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Mario Simental-Mendía
Universidad Autonoma de Nuevo Leon
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Abstract

Purpose. Reports have concluded that platelet-rich plasma (PRP) is an effective and safe biological approach to treating knee osteoarthritis (OA). However, the efficacy of PRP in advanced stages of the disease is not entirely clear. The purpose of this study was to evaluate whether the use of PRP would be as effective in studies with early-moderate knee OA patients compared to studies including patients with end-stage OA based on the Kellgren-Lawrence classification. Methods. A comprehensive search in MEDLINE, EMBASE, Scopus, and Web of Science was conducted to identify randomized controlled trials (RCTs) comparing the effect of PRP injections versus other intra-articular treatments on pain and functionality. A meta-analysis was conducted using a random-effects model and the generic inverse variance method. Results. We included 31 clinical trials that reported data of 2705 subjects. Meta-analysis revealed an overall significant improvement of both pain (MD, -1.05 [95% CI -1.41 to -0.68]; I2 = 86%; P = < 0.00001) and function (SMD, -0.99 [95% CI -1.34, to -0.65]; I2 = 94%; P = < 0.00001), favoring PRP. Subanalysis for pain and functional improvement showed significant pain relief in studies with 1-3 and 1-4 Kellgren-Lawrence OA stages, and a significant functional improvement in studies with 1-2, 1-3, and 1-4 knee OA stages, favoring PRP. Conclusion. Our results indicate that including patients with advanced knee OA does not seem to affect the outcomes of clinical trials in which the efficacy of PRP in knee OA is assessed.