皮质类固醇与富血小板血浆注射治疗膝关节骨关节炎：哪里有更多证据？对60年文献的系统回顾

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee Pub Date : 2025-04-24 DOI:10.1016/j.knee.2025.03.010

Angelo Boffa , Giacomo Moraca , Alessandro Sangiorgio , Alessandro Di Martino , Alessandro Bensa , Giuseppe Filardo

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引用次数: 0

摘要

国际协会经常推荐皮质类固醇（CS）注射用于治疗膝关节骨关节炎（OA），但在比较分析中富血小板血浆（PRP）显示出更高的安全性和有效性。尽管如此，由于缺乏足够的证据，PRP的使用通常不被科学协会认可。本研究旨在量化记录CS和PRP关节内注射治疗膝关节OA的临床数据。方法系统回顾CS和PRP注射治疗膝关节OA的相关文献。该检索于2024年3月进行，使用PubMed、Cochrane和Web of Science数据库，遵循PRISMA和Cochrane指南。收集的数据包括发表趋势、文章数量、评估的患者以及记录CS或PRP注射的研究设计。结果在16,979份记录中，分析了356项研究，涵盖24,435例膝关节OA患者。两种处理的发表量均呈增加趋势，到2020年PRP将超过CS。分析包括9,322例CS患者和15,113例PRP患者。在CS研究中，103项随机对照试验（rct）纳入5478例患者，18项比较研究纳入1095例患者，31项病例系列纳入2749例患者。在PRP研究中，有119项随机对照试验涉及6028例患者，33项比较研究涉及2011例患者，72项病例系列研究涉及7074例患者。结论与CS注射相比，sprp注射治疗膝关节OA的研究更多，患者数量也更多。PRP的高水平试验数量较多，加上之前直接比较两种产品的荟萃分析记录的CS的安全性和有效性较低，强烈建议重新考虑支持CS的现行指南，强调PRP的证据体和在有效和安全治疗膝关节OA中的潜在作用。

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Corticosteroids versus platelet-rich plasma injections for knee osteoarthritis: Where is there more evidence? A systematic review of 60 years of literature

Background

Corticosteroid (CS) injections are often recommended by international societies for knee osteoarthritis (OA) treatment, but platelet-rich plasma (PRP) has shown higher safety and efficacy in comparative analyses. Despite this, PRP use is often not endorsed by scientific societies due to perceived insufficient body of evidence. This study aims to quantify clinical data documenting CS and PRP intra-articular injections for knee OA.

Methods

A systematic review of the literature was conducted on CS and PRP injections for knee OA. The search, performed in March 2024, used PubMed, Cochrane, and Web of Science databases, following PRISMA and Cochrane guidelines. Data collected included publication trends, number of articles, patients evaluated, and study designs documenting CS or PRP injections.

Results

Of 16,979 records, 356 studies were analyzed, covering 24,435 knee OA patients. Both treatments showed an increasing publication trend, with PRP surpassing CS in 2020. The analysis included 9,322 CS patients and 15,113 PRP patients. Among CS studies, there were 103 RCTs with 5,478 patients, 18 comparative studies with 1,095 patients, and 31 case series with 2,749 patients. Among PRP studies, there were 119 RCTs with 6,028 patients, 33 comparative studies with 2,011 patients, and 72 case series with 7,074 patients.

Conclusions

PRP injections for knee OA have been documented in more studies and in larger patient numbers compared with CS injections. The higher number of high-level trials for PRP, combined with the lower safety and efficacy documented for CS by previous meta-analyses directly comparing the two products, strongly suggests reconsidering current guidelines that favor CS, highlighting PRP’s body of evidence and the potential role in the effective and safe treatment of knee OA.

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来源期刊

Knee 医学-外科

CiteScore

3.80

自引率

5.30%

发文量

171

审稿时长

6 months

期刊介绍： The Knee is an international journal publishing studies on the clinical treatment and fundamental biomechanical characteristics of this joint. The aim of the journal is to provide a vehicle relevant to surgeons, biomedical engineers, imaging specialists, materials scientists, rehabilitation personnel and all those with an interest in the knee. The topics covered include, but are not limited to: • Anatomy, physiology, morphology and biochemistry; • Biomechanical studies; • Advances in the development of prosthetic, orthotic and augmentation devices; • Imaging and diagnostic techniques; • Pathology; • Trauma; • Surgery; • Rehabilitation.