Orthopaedic Journal of Sports Medicine
The Efficacy of Platelet-Rich Plasma Alone Versus Platelet-Rich Plasma Combined With Hyaluronic Acid in the Treatment Of Knee Osteoarthritis: A Systematic Review and Meta-Analysis
By E. Pasqualotto, T. Pasqualotto, L. Lunelli and 3 others.
Abstract
Objectives
To compare the clinical efficacy of platelet-rich plasma (PRP) alone versus PRP combined with hyaluronic acid (HA) in adults with knee osteoarthritis.
Methods
PubMed, Embase, and the Cochrane Library were systematically searched for randomized controlled trials (RCTs) published up to December 2025 comparing PRP alone with PRP combined with HA in patients with knee osteoarthritis. Mean differences (MDs) were calculated for continuous outcomes, with 95% confidence intervals (CIs).
Results
A total of 10 RCTs comprising 822 patients were included. The PRP + HA group showed statistically significant superiority for VAS at 6 months (MD 0.49 mm; 95% CI 0.07 to 0.90), IKDC at 3 months (MD -4.48 points; 95% CI -7.87 to -1.08) and 6 months (MD -4.86 points; 95% CI -8.09 to -1.62), WOMAC total score at 12 months (MD 4.28 points; 95% CI 1.71 to 6.85), WOMAC physical function at 12 months (MD 4.56 points; 95% CI 2.23 to 6.90), and WOMAC stiffness at 1 month (MD -0.48 points; 95% CI -0.95 to -0.01). No significant differences were observed between groups for the Lequesne Index, KOOS scores, or WOMAC pain subscale at any follow-up interval.