Efficacy of Platelet-Rich Plasma versus Corticosteroid Injections in Knee Osteoarthritis: A Systematic Review and Meta-Analysis
DOI:
https://doi.org/10.51168/2w42b964Keywords:
knee osteoarthritis, platelet-rich plasma, corticosteroid, intra-articular injection, randomized trial, meta-analysis, PRISMA 2020Abstract
Background: Intra-articular corticosteroids can provide rapid but short-lived symptom relief in knee osteoarthritis (OA), while platelet-rich plasma (PRP) may offer a more durable effect through biologic modulation.
Aim: To compare the efficacy and safety of intra-articular PRP versus intra-articular corticosteroid injections in adults with knee OA.
Methods: MEDLINE/PubMed, CENTRAL, and ClinicalTrials.gov were searched (last search: 9 January 2026) using prespecified, reproducible strategies. Comparative adult human clinical studies directly comparing PRP with intra-articular corticosteroid for knee OA were eligible. Primary outcomes were pain and function at prespecified windows (1–3 months, ~6 months, ~12 months). Random-effects meta-analysis (DerSimonian–Laird) pooled standardized mean differences (SMD; Hedges g). Risk of bias was assessed using RoB 2, and certainty of evidence was appraised with GRADE.
Results: From 330 records (databases n=312; registers n=18), 234 records were screened after duplicate removal, and 18 full-text reports were assessed; 4 studies were included in the review. Three parallel-group randomized trials (total randomized n=154; analyzed n≈150 across outcomes) contributed continuous data to meta-analysis. At 1–3 months, PRP did not differ from corticosteroid for pain (SMD −0.15, 95% CI −0.59 to 0.30; I²=44%) or function (SMD 0.11, 95% CI −0.22 to 0.44; I²=0%). At ~6 months, PRP improved pain (SMD −0.79, 95% CI −1.38 to −0.19; I²=66%) and function (SMD 0.75, 95% CI 0.25 to 1.25; I²=52%) versus corticosteroid. At ~12 months (one trial), results favored PRP for both pain (SMD −1.27, 95% CI −1.99 to −0.55) and function (SMD 1.36, 95% CI 0.63 to 2.09). No serious adverse events were reported; one trial noted transient mild synovitis after PRP that resolved spontaneously.
Conclusion: PRP and corticosteroid injections provide similar short-term outcomes (1–3 months). By ~6 months, PRP shows greater pain reduction and functional improvement, though heterogeneity and variable PRP protocols temper certainty. E
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