24.3.8 - Intra-Articular Injections in the Treatment of Knee Osteoarthritis: A Systematic Review and Network Meta-Analysis
- A. Yanke (Chicago, US)
- O. Lavoie-Gagne (Boston, US)
- H. Huddleston (Chicago, US)
- R. Memon (Rochester, US)
- E. Berlinberg (Chicago, US)
- A. Yanke (Chicago, US)
- B. Forsythe (Chicago, US)
Abstract
Purpose
The purpose of this study was to construct an algorithm to optimize clinical outcomes prior to definitive surgical management in patients with symptomatic knee OA.
Methods and Materials
A systematic review of randomized controlled trials on IA injections for symptomatic knee OA without severe degenerative changes from the inception of databases to December 18th, 2019 was performed. Interventions were compared via arm-based Bayesian network meta-analysis in a random-effects model and interventions ranked for each domain (ROM, pain, PROs) via surface under the cumulative ranking curves.
Results
A total of 39 studies comprising 2,764 knees (60% females, age 57 ± 4 years, follow-up 10 ± 5 months) were included. There were no significant differences in preoperative PROs between injection groups. Interventions ranked highest for improved ROM included fetal-derived mesenchymal stem cells (MSC.Fetal), adipose-derived mesenchymal stem cells (MSC.Ad), and bone-marrow derived stem cells (MSC.BM). Interventions ranked highest for improved pain included all MSC injections and platelet rich plasma (PRP), with or without hyaluronic acid (HA). These injections ranked equally high within the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales. Corticosteroid and HA injections ranked relatively poorly across all ROM, pain, and PRO domains.
Conclusion
PRP and MSC injections offer excellent clinical improvements in pain, ROM, and PROs, exceeding minimal clinically important difference thresholds. On the other hand, CSI and HA injections, in isolation, demonstrated relatively poor clinical outcomes with often non-statistically significant effects for pain, ROM, and PRO outcomes. Thus, for patients with symptomatic knee OA amenable to treatment by injection, the authors recommend either PRP, with or without HA, or MSC injection.