Platelet-rich plasma provides greater pain relief and functional improvement than hyaluronic acid for knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials.

Published on January 1, 2026 by FH A, D A, RM S, AA A, MK A

Key Takeaway

A meta-analysis shows intra-articular platelet-rich plasma improves pain and function more than hyaluronic acid in knee osteoarthritis, especially when using leukocyte-poor formulations in early-stage disease.

FH A., D A., RM S., AA A., MK A.. (2026). Platelet-rich plasma provides greater pain relief and functional improvement than hyaluronic acid for knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials.

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Topics
Arthrose

What this study found

This systematic review and meta-analysis of 28 randomized controlled trials involving 2,685 participants evaluated the performance of intra-articular platelet-rich plasma (PRP) compared to hyaluronic acid (HA) for symptomatic knee osteoarthritis. The pooled analysis demonstrated that PRP yielded significantly superior improvements in functional recovery (WOMAC total score) and pain reduction (VAS). Crucially, meta-regression and subgroup analyses revealed that clinical benefits were optimized when using leukocyte-poor PRP preparations, administering multiple-injection series, and treating patients with mild-to-moderate disease (Kellgren-Lawrence grades I–II).

Why it matters

In non-surgical sports medicine and physical rehabilitation, intra-articular injections provide a critical bridge between oral analgesics or exercise therapy and total joint arthroplasty. These findings offer practical guidance for clinicians structuring orthobiologic regimens. Rather than treating PRP as a uniform intervention, practitioners should tailor treatment parameters—favoring multi-dose, leukocyte-depleted protocols early in the disease process to maximize functional gains. While HA remains a viable secondary option, PRP presents a strong evidence-backed choice for appropriate candidates.

Limitations

Clinicians should consider several methodological limitations when reviewing these results:

  • High statistical heterogeneity: Variations in PRP preparation techniques, platelet concentrations, and injection intervals across trials introduce noise into pooled estimates.
  • Variable evidence certainty: Evidence certainty was rated as moderate for functional improvement but low for pain reduction due to study design vulnerabilities in smaller trials.
  • Standardization gaps: The lack of standardized commercial preparation kits prevents clear head-to-head dosing recommendations.

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