<p>Periarticular hypertonic dextrose vs intraarticular hyaluronic acid injections: a comparison of two minimally invasive techniques in the treatment of symptomatic knee osteoarthritis</p>

Background: Although platelet-rich plasma (PRP) has potential as a regenerative treatment for knee osteoarthritis, its efficacy varies. Compositional differences among types of PRP could affect clinical outcomes, but the biological characterization of PRP is lacking. Purpose: To assess the efficacy of intra-articular PRP injection in knee osteoarthritis as compared with hyaluronic acid (HA) injection and to determine whether the clinical efficacy of PRP is associated with its biological characteristics. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 110 patients with symptomatic knee osteoarthritis received a single injection of leukocyte-rich PRP (1 commercial kit) or HA. Clinical data were assessed at baseline and at 6 weeks and 3 and 6 months after injection. The primary endpoint was an improvement in the International Knee Documentation Committee (IKDC) subjective score at 6 months, and the secondary endpoints were improvements in scores based on the Patient Global Assessment, the visual analog scale (VAS) for pain, the Western Ontario and McMaster Universities Osteoarthritis Index, and the Samsung Medical Center patellofemoral score. Cell counts and concentrations of growth factors and cytokines in the injected PRP were assessed to determine their association with clinical outcomes. Results: PRP showed significantly improvement in IKDC subjective scores at 6 months (11.5 in the PRP group vs 6.3 in the HA group; P = .029). There were no significant differences between groups in other clinical outcomes. The Patient Global Assessment score at 6 months was better in the PRP group ( P = .035). The proportion of patients who scored above the minimal clinically important difference (MCID) for VAS at 6 months was significantly higher in the PRP group ( P = .044). Within the PRP group, the concentrations of platelet-derived growth factors were high in patients with a score above the MCID for VAS at 6 months. The incidence of adverse events did not differ between the groups ( P > .05). Conclusion: PRP had better clinical efficacy than HA. High concentrations of growth factors were observed in patients who scored above the MCID for clinical outcomes in the PRP group. These findings indicate that concentration of growth factors needs to be taken into consideration for future investigations of PRP in knee osteoarthritis. Registration: NCT02211521 (ClinicalTrials.gov identifier).

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Safety and efficacy of intra articular injections of a combination of hyaluronic acid and mannitol (HAnOX-M) in patients with symptomatic knee osteoarthritis. Results of a double-blind, controlled, multicenter, randomized trial

Osteoarthritis and Cartilage ◽

10.1016/j.joca.2016.01.966 ◽

2016 ◽

Vol 24 ◽

pp. S528

Author(s):

T. Conrozier ◽

N. Afif ◽

R. Lecurieux ◽

A. Walliser ◽

X. Chevalier

Keyword(s):

Hyaluronic Acid ◽

Knee Osteoarthritis ◽

Randomized Trial ◽

Double Blind ◽

Safety And Efficacy ◽

Multicenter Randomized Trial ◽

Symptomatic Knee Osteoarthritis ◽

Symptomatic Knee

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US-Approved Intra-Articular Hyaluronic Acid Injections are Safe and Effective in Patients with Knee Osteoarthritis: Systematic Review and Meta-Analysis of Randomized, Saline-Controlled Trials

Clinical Medicine Insights Arthritis and Musculoskeletal Disorders ◽

10.4137/cmamd.s12743 ◽

2013 ◽

Vol 6 ◽

pp. CMAMD.S12743 ◽

Cited By ~ 91

Author(s):

Larry E. Miller ◽

Jon E. Block

Keyword(s):

Systematic Review ◽

Hyaluronic Acid ◽

Knee Osteoarthritis ◽

Knee Pain ◽

Meta Analysis ◽

Controlled Trials ◽

Serious Adverse Events ◽

Safety Outcome ◽

Symptomatic Knee Osteoarthritis ◽

Symptomatic Knee

We conducted a systematic review and meta-analysis of randomized saline-controlled trials to determine the safety and efficacy of US-approved intra-articular hyaluronic acid (IAHA) injections for symptomatic knee osteoarthritis. A total of 29 studies representing 4,866 unique subjects (IAHA: 2,673, saline: 2,193) were included. IAHA injection resulted in very large treatment effects between 4 and 26 weeks for knee pain and function compared to pre-injection values, with standardized mean difference (SMD) values ranging from 1.07–1.37 (all P < 0.001). Compared to saline controls, SMDs with IAHA ranged from 0.38–0.43 for knee pain and 0.32–0.34 for knee function (all P < 0.001). There were no statistically significant differences between IAHA and saline controls for any safety outcome, including serious adverse events (SAEs) ( P = 0.12), treatment-related SAEs ( P = 1.0), study withdrawal ( P = 1.0), and AE-related study withdrawal ( P = 0.46). We conclude that intra-articular injection of US-approved HA products is safe and efficacious in patients with symptomatic knee osteoarthritis.

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Safety and efficacy of intra-articular injections of a combination of hyaluronic acid and mannitol (HAnOX-M) in patients with symptomatic knee osteoarthritis

The Knee ◽

10.1016/j.knee.2016.05.015 ◽

2016 ◽

Vol 23 (5) ◽

pp. 842-848 ◽

Cited By ~ 6

Author(s):

Thierry Conrozier ◽

Florent Eymard ◽

Naji Afif ◽

Jean-Charles Balblanc ◽

Virginie Legré-Boyer ◽

...

Keyword(s):

Hyaluronic Acid ◽

Knee Osteoarthritis ◽

Safety And Efficacy ◽

Symptomatic Knee Osteoarthritis ◽

Symptomatic Knee

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Hypertonic dextrose injections (prolotherapy) in the treatment of symptomatic knee osteoarthritis: A systematic review and meta-analysis

Scientific Reports ◽

10.1038/srep25247 ◽

2016 ◽

Vol 6 (1) ◽

Cited By ~ 29

Author(s):

Regina WS Sit ◽

Vincent CH Chung ◽

Kenneth D. Reeves ◽

David Rabago ◽

Keith KW Chan ◽

...

Keyword(s):

Systematic Review ◽

Knee Osteoarthritis ◽

Primary Outcome ◽

Meta Analysis ◽

Knee Oa ◽

Composite Scale ◽

Symptomatic Knee Osteoarthritis ◽

Symptomatic Knee ◽

Pain Subscale ◽

Hypertonic Dextrose

Abstract Hypertonic dextrose injections (prolotherapy) is an emerging treatment for symptomatic knee osteoarthritis (OA) but its efficacy is uncertain. We conducted a systematic review with meta-analysis to synthesize clinical evidence on the effect of prolotherapy for knee OA. Fifteen electronic databases were searched from their inception to September 2015. The primary outcome of interest was score change on the Western Ontario and McMaster Universities Arthritis Index (WOMAC). Three randomized controlled trials (RCTs) of moderate risk of bias and one quasi–randomized trial were included, with data from a total of 258 patients. In the meta-analysis of two eligible studies, prolotherapy is superior to exercise alone by a standardized mean difference (SMD) of 0.81 (95% CI: 0.18 to 1.45, p = 0.012), 0.78 (95% CI: 0.25 to 1.30, p = 0.001) and 0.62 (95% CI: 0.04 to 1.20, p = 0.035) on the WOMAC composite scale; and WOMAC function and pain subscale scores respectively. Moderate heterogeneity exists in all cases. Overall, prolotherapy conferred a positive and significant beneficial effect in the treatment of knee OA. Adequately powered, longer-term trials with uniform end points are needed to better elucidate the efficacy of prolotherapy.

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