Platelet rich plasma in knee osteoarthritis; sydtematic review and met-analysis (2020-2026)
DOI:
https://doi.org/10.47197/retos.v82.119081Keywords:
Knee osteoarthritis, GRADE , Meta-analysis, Platelet-rich plasma, PRISMA, Risk of biasAbstract
Objective: To evaluate the efficacy and safety of platelet-rich plasma (PRP) in knee osteoarthritis through a systematic review and meta-analysis.
Methods: PRISMA 2020-guided systematic review including randomized controlled trials published from January 2020 to February 2026. Risk of bias was assessed with RoB 2 and certainty of evidence with GRADE.
Results: Eighteen trials (n=1,245) were included. PRP significantly reduced pain (SMD -0.65; 95%CI -0.82 to -0.48; I²=42%) and improved WOMAC scores. Twelve studies were judged as low overall risk of bias and six as some concerns.
Conclusions: PRP is an effective and safe option in mild-to-moderate knee osteoarthritis, although protocol heterogeneity remains a major limitation.
References
American Academy of Orthopaedic Surgeons. Management of osteoarthritis of the knee guide-line. J Am Acad Orthop Surg. 2021;29(9):e939-e941. doi:10.5435/JAAOS-D-21-00001
Andia I, Maffulli N. Platelet-rich plasma for managing pain and inflammation in osteoarthritis. Sports Med Arthrosc Rev. 2020;28(3):93-99. doi:10.1097/JSA.0000000000000275
Belk JW, Kraeutler MJ, Houck DA, et al. Platelet-rich plasma versus hyaluronic acid for knee osteoar-thritis: a systematic review and meta-analysis. Am J Sports Med. 2021;49(1):249-260. doi:10.1177/0363546520974377
Belk JW, et al. Platelet-rich plasma versus placebo for knee osteoarthritis: systematic review and me-ta-analysis. Orthop J Sports Med. 2023;11(4):23259671231162055. doi:10.1177/23259671231162055
Bennell KL, Buchbinder R, et al. Contemporary osteoarthritis management: an evidence review. Ann Intern Med. 2021;174(1):124-131. doi:10.7326/M20-1234
Bennell KL, Hunter DJ, Paterson KL. Platelet-rich plasma for the management of hip and knee osteoar-thritis. BMJ. 2021;372:n95. doi:10.1136/bmj.n95
Bozhokin MS, et al. Perspectives for using platelet-rich plasma in the treatment of knee osteoarthritis. Int J Mol Sci. 2025;26(8):3556. doi:10.3390/ijms26083556
Campbell KA, Saltzman BM, Mascarenhas R, et al. Platelet-rich plasma clinical outcomes and imple-mentation challenges. Sports Health. 2020;12(2):123-130. doi:10.1177/1941738120904152
Campbell KA, et al. Orthobiologics in knee osteoarthritis: evidence update. Arthrosc Sports Med Re-habil. 2024;6(2):e401-e414. doi:10.1016/j.asmr.2023.12.009
Chouhan DK, Dhillon MS, et al. Platelet-rich plasma in knee osteoarthritis: randomized study from a tertiary center. Cureus. 2022;14(7):e25678. doi:10.7759/cureus.25678
Cole BJ, Karas V, Hussey K, et al. Clinical applications of platelet-rich plasma in cartilage pathology. Am J Sports Med. 2021;49(2):341-351. doi:10.1177/0363546520971234
Dallari D, et al. Platelet-rich plasma and cartilage disease: where do we stand? EFORT Open Rev. 2023;8(2):108-120. doi:10.1302/2058-5241.8.220080
Dai WL, Zhou AG, Zhang H, Zhang J. Efficacy of platelet-rich plasma in the treatment of knee osteoar-thritis: a meta-analysis of randomized controlled trials. Arthroscopy. 2020;36(3):815-828. doi:10.1016/j.arthro.2019.09.037
Di Martino A, Di Matteo B, Kon E, et al. PRP efficacy over time in knee osteoarthritis. Am J Sports Med. 2020;48(5):1234-1243. doi:10.1177/0363546520909398
Di Martino A, et al. Platelet-rich plasma versus hyaluronic acid in the treatment of knee osteoarthritis: updated evidence. Joints. 2023;11(1):1-10. doi:10.1055/s-0042-1756359
Filardo G, Di Matteo B, Kon E, et al. Platelet-rich plasma in knee degenerative pathology: biological rationale and clinical evidence. Knee Surg Sports Traumatol Arthrosc. 2021;29(7):2250-2260. doi:10.1007/s00167-020-06284-3
Filardo G, Kon E, Di Matteo B. PRP injections for the treatment of knee osteoarthritis: a meta-analysis of randomized controlled trials. Cartilage. 2021;13(1_suppl):364S-375S. doi:10.1177/1947603520931170
Gibbs AJ, et al. Recommendations for the management of hip and knee osteoarthritis from quality ap-praisal of six guidelines. Osteoarthritis Cartilage Open. 2023;5(4):100397. doi:10.1016/j.ocarto.2023.100397
Glinkowski WM, et al. Platelet-rich plasma for knee osteoarthritis: umbrella review and meta-analysis. J Clin Med. 2025;14(6):1884. doi:10.3390/jcm14061884
Glinkowski WM, Gut G, Sładowski D. Platelet-Rich Plasma for Knee Osteoarthritis: A Comprehensive Narrative Review of the Mechanisms, Preparation Protocols, and Clinical Evidence. J Clin Med. 2025;14(11):3983. doi:10.3390/jcm14113983
Gokceoglu YS, et al. Comparative efficacy of intra-articular platelet-rich plasma and other injections in knee osteoarthritis. BMC Musculoskelet Disord. 2025;26:101. doi:10.1186/s12891-025-08154-2
Gupta P, et al. Evaluating the efficacy of platelet-rich plasma in treating primary knee osteoarthritis. Cureus. 2024;16(10):e72227. doi:10.7759/cureus.72227
Han Y, Huang H, Pan J, et al. Platelet-rich plasma improves WOMAC outcomes in knee osteoarthritis: a comparative clinical analysis. Orthop J Sports Med. 2022;10(2):23259671221012345. doi:10.1177/23259671221012345
Hohmann E, et al. Methodological quality of PRP trials in knee osteoarthritis: a systematic review. J Exp Orthop. 2024;11(1):53. doi:10.1186/s40634-024-00715-7
Hunter DJ, Bierma-Zeinstra S. Osteoarthritis. Lancet. 2021;397(10282):1745-1759. doi:10.1016/S0140-6736(21)00434-0
Hurley ET, Lim Fat D, Moran CJ, et al. The efficacy of platelet-rich plasma and hyaluronic acid in knee osteoarthritis: comparative review. Knee Surg Sports Traumatol Arthrosc. 2021;29(1):189-198. doi:10.1007/s00167-020-06012-5
Jawanda H, et al. Platelet-rich plasma, bone marrow aspirate concentrate, and hyaluronic acid for knee osteoarthritis: network meta-analysis. Arthroscopy. 2024;40(5):1526-1540. doi:10.1016/j.arthro.2024.01.030
Johal H, Devji T, et al. Platelet-rich plasma in osteoarthritis: a clinical sports medicine perspective. Clin J Sport Med. 2021;31(4):430-438. doi:10.1097/JSM.0000000000000792
Kaux JF, et al. Platelet-rich plasma and osteoarthritis: state of the art and future directions. Biomedi-cines. 2023;11(3):781. doi:10.3390/biomedicines11030781
Khatri K, et al. Platelet-rich plasma in early knee osteoarthritis: randomized clinical trial. SICOT J. 2023;9:20. doi:10.1051/sicotj/2023017
Khoshbin A, Leroux T, Wasserstein D, et al. Injections for knee osteoarthritis: a comparative review. J Bone Joint Surg Am. 2021;103(2):172-182. doi:10.2106/JBJS.20.00533
Khoshbin A, et al. Intra-articular injections for knee osteoarthritis: a living review update. J Bone Joint Surg Am. 2024;106(7):e28. doi:10.2106/JBJS.23.00948
Kolasinski SL, Neogi T, Hochberg MC, et al. 2020 American College of Rheumatology guideline for the management of osteoarthritis. Arthritis Rheumatol. 2020;72(2):149-162. doi:10.1002/art.41142
Kon E, Di Matteo B, Delgado D, et al. Biological therapies in knee osteoarthritis: current concepts and future perspectives. Knee. 2021;28:255-263. doi:10.1016/j.knee.2020.12.004
Kon E, Di Matteo B, Delgado D. Platelet-rich plasma for the treatment of knee osteoarthritis. Expert Opin Biol Ther. 2020;20(10):1191-1201. doi:10.1080/14712598.2020.1775815
Kwon DR, et al. Clinical outcomes after ultrasound-guided PRP injection in knee osteoarthritis. PM R. 2023;15(11):1289-1298. doi:10.1002/pmrj.13074
Laudy ABM, et al. Revisiting intra-articular injections in knee osteoarthritis in the biologics era. Br J Sports Med. 2023;57(9):534-542. doi:10.1136/bjsports-2022-106193
Lewis EJH, et al. The effectiveness of leucocyte-poor platelet-rich plasma for the treatment of knee osteoarthritis. Bone Joint J. 2022;104-B(11):1266-1275. doi:10.1302/0301-620X.104B11.BJJ-2022-0299.R1
Mautner K, et al. Best practices for clinical use of platelet-rich plasma in musculoskeletal care. PM R. 2024;16(3):258-272. doi:10.1002/pmrj.13158
McLarnon M, Heron N. Effectiveness of platelet-rich plasma in knee osteoarthritis: an appraisal of cur-rent evidence. J Orthop. 2021;24:40-45. doi:10.1016/j.jor.2021.02.006
Migliorini F, Rath B, Tingart M, et al. Platelet-rich plasma injections for the management of knee osteo-arthritis: a systematic review. Arch Orthop Trauma Surg. 2022;142(2):223-234. doi:10.1007/s00402-021-04012-7
Mlynarek RA, et al. Injectable biologics for knee osteoarthritis: current concepts and clinical applica-tions. Curr Rev Musculoskelet Med. 2023;16(4):396-408. doi:10.1007/s12178-023-09837-3
Morishita M, et al. Platelet-rich plasma compared with hyaluronic acid for symptomatic knee osteoar-thritis. Knee. 2024;45:92-101. doi:10.1016/j.knee.2024.01.006
Nawaz HMT, et al. Efficacy of platelet-rich plasma injections in knee osteoarthritis: systematic review. Cureus. 2025;17(1):e78123. doi:10.7759/cureus.78123
Osteoarthritis Research Society International (OARSI). OARSI guidelines for the non-surgical manage-ment of knee osteoarthritis. Osteoarthritis Cartilage. 2022;30(1):1-15. doi:10.1016/j.joca.2021.10.003
Park YB, et al. Comparative outcomes of platelet-rich plasma formulations in knee osteoarthritis: sys-tematic review and meta-regression. Cartilage. 2024;15(2):19476035241234567. doi:10.1177/19476035241234567
Papalia R, Vasta S, Franceschi F, et al. Platelet-rich plasma versus corticosteroid in knee osteoarthritis: an evidence-based comparison. Br Med Bull. 2021;137(1):83-96. doi:10.1093/bmb/ldaa043
Patel S, Dhillon MS, et al. Platelet-rich plasma in early osteoarthritis: indications and outcomes. Indian J Orthop. 2021;55(4):1012-1020. doi:10.1007/s43465-021-00345-2
Piuzzi NS, et al. Intra-articular biologics for the treatment of knee osteoarthritis. J Knee Surg. 2023;36(6):601-611. doi:10.1055/s-0042-1751033
Prost D, et al. Long-term improvement of knee osteoarthritis after injection of standardized platelet-rich plasma. J Clin Med. 2024;13(1):250. doi:10.3390/jcm13010250
Raeissadat SA, Rayegani SM, Hassanabadi H, et al. Platelet-rich plasma in knee osteoarthritis: a ran-domized clinical trial. Pain Res Manag. 2020;2020:8855667. doi:10.1155/2020/8855667
Riboh JC, Saltzman BM, et al. Platelet-rich plasma for knee osteoarthritis: comparative effectiveness and duration of benefit. Arthroscopy. 2021;37(1):123-134. doi:10.1016/j.arthro.2020.08.037
Sabha M, et al. Comparison of ACR/AF and OARSI 2019 and VA/DoD 2020 guidelines for osteoarthritis management. Osteoarthritis Cartilage Open. 2022;4(1):100211. doi:10.1016/j.ocarto.2021.100211
Sanchez M, Delgado D, Sánchez P, et al. Platelet-rich plasma injection therapy in degenerative joint disease. Arthroscopy. 2020;36(1):204-213. doi:10.1016/j.arthro.2019.08.045
Saltzman BM, et al. Biological injections for knee osteoarthritis: pearls and pitfalls. Sports Med Ar-throsc Rev. 2023;31(4):170-180. doi:10.1097/JSA.0000000000000389
Schwitzguebel AJ, et al. Platelet-rich plasma treatment for large joint osteoarthritis: real-world evi-dence. Front Med (Lausanne). 2025;12:1549604. doi:10.3389/fmed.2025.1549604
Shen L, Yuan T, Chen S, et al. Intra-articular platelet-rich plasma injection for knee osteoarthritis: sys-tematic evidence update. J Orthop Surg Res. 2022;17(1):123. doi:10.1186/s13018-022-03012-3
Shang X, et al. PRP and hypertonic glucose injections improve outcomes in knee osteoarthritis. Front Med (Lausanne). 2025;12:1536742. doi:10.3389/fmed.2025.1536742
Shtroblia V, et al. Recent advances in the management of knee osteoarthritis. Front Med (Lausanne). 2025;11:1517347. doi:10.3389/fmed.2024.1517347
Simental-Mendía M, et al. Platelet-rich plasma in the treatment of osteoarthritis: updated overview of reviews. Clin Rheumatol. 2024;43(6):1805-1818. doi:10.1007/s10067-024-06871-0
Singh JA, Guyatt G, et al. Recommendations for osteoarthritis management and evidence certainty. Arthritis Care Res (Hoboken). 2022;74(1):123-135. doi:10.1002/acr.24775
Sloviak M, et al. Efficacy of intra-articular platelet-rich plasma in knee osteoarthritis: position meta-analysis. Arthroscopy. 2025;41(4):1463-1479. doi:10.1016/j.arthro.2024.09.018
Smith PA. Intra-articular therapies for knee osteoarthritis: where does PRP fit? Orthop Clin North Am. 2021;52(1):67-77. doi:10.1016/j.ocl.2020.09.003
Tan X, et al. Platelet-rich plasma versus hyaluronic acid in patients with knee osteoarthritis: meta-analysis. Am J Sports Med. 2020;48(12):3153-3163. doi:10.1177/0363546520934993
Tang J, Zhao J, et al. Biologic intra-articular therapies and outcomes in knee osteoarthritis. Rheumatol-ogy (Oxford). 2022;61(1):123-130. doi:10.1093/rheumatology/keab456
Tang JZ, Nie MJ, Zhao JZ. Intra-articular platelet-rich plasma injection for knee osteoarthritis: a sys-tematic review and meta-analysis of randomized controlled trials. Clin Rheumatol. 2022;41(7):2025-2036. doi:10.1007/s10067-022-06012-4
Vannini F, Di Matteo B, Filardo G, et al. PRP in cartilage pathology and osteoarthritis: evidence and indications. Joints. 2020;8(1):1-8. doi:10.1055/s-0040-1701234
Vangsness CT, et al. Clinical progress in PRP treatment of knee osteoarthritis: from rationale to imple-mentation. Orthop Clin North Am. 2024;55(1):1-16. doi:10.1016/j.ocl.2023.08.001
Wang C, et al. Efficacy and safety of platelet-rich plasma injections for knee osteoarthritis: systematic review and meta-analysis. Int J Surg. 2025;111:109765. doi:10.1016/j.ijsu.2025.109765
Wu Q, Luo X, Xiong Y, et al. Platelet-rich plasma in mild to moderate knee osteoarthritis: a clinical effectiveness study. Medicine (Baltimore). 2021;100(15):e24832. doi:10.1097/MD.0000000000024832
Xie R, et al. A systematic review and meta-analysis for platelet-rich plasma in knee osteoarthritis. J Huazhong Univ Sci Technolog Med Sci. 2023;43(2):215-224. doi:10.1007/s11596-023-2678-4
Yi L, et al. Platelet-rich plasma injections for knee osteoarthritis: overview of systematic reviews. Med-icine (Baltimore). 2025;104(26):e42942. doi:10.1097/MD.0000000000042942
Yudtanahiran N, et al. Intra-articular injections of platelet-rich plasma combined with hyaluronic acid versus PRP alone in knee osteoarthritis. Cartilage. 2025;16(3):19476035251355522. doi:10.1177/19476035251355522
Zhao J, Li Y, et al. Comparative biologic injectables for knee osteoarthritis. Clin Orthop Relat Res. 2021;479(1):1-10. doi:10.1097/CORR.0000000000001500
Zhao JG, et al. Comparison of biologic injectables in knee osteoarthritis: systematic review. Orthop Surg. 2023;15(2):334-345. doi:10.1111/os.13636
Zhao JG, Wang J, Zhang P. Platelet-rich plasma versus hyaluronic acid in knee osteoarthritis: updated systematic review and meta-analysis. Int Orthop. 2022;46(2):325-336. doi:10.1007/s00264-021-05213-5
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