Comparative efficacy of platelet-rich plasma monotherapy versus combination therapies for knee osteoarthritis: a systematic review and network meta-analysis.

Published on January 1, 2026 by D L, X Z, Z Z, X M, H B

Key Takeaway

A network meta-analysis shows that combining platelet-rich plasma with hyaluronic acid offers superior pain relief and functional improvement for knee osteoarthritis compared to PRP alone or other combinations.

D L., X Z., Z Z., X M., H B.. (2026). Comparative efficacy of platelet-rich plasma monotherapy versus combination therapies for knee osteoarthritis: a systematic review and network meta-analysis.

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Topics
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What this study found

This systematic review and network meta-analysis synthesized data from 18 randomized controlled trials involving 1,376 adults to clarify whether combining intra-articular platelet-rich plasma (PRP) with other therapies yields better outcomes for knee osteoarthritis. The investigators compared PRP monotherapy against PRP combined with hyaluronic acid (HA), mesenchymal stem cells (MSCs), or medical ozone gas.

The combination of PRP plus HA demonstrated superior efficacy over PRP alone, achieving statistically significant improvements in both WOMAC functional scores and VAS pain ratings. Conversely, combining PRP with MSCs or ozone failed to demonstrate statistically significant clinical advantages over PRP monotherapy. Based on cumulative ranking probabilities, the PRP-HA co-injection strategy ranked highest for overall pain relief.

Why it matters

Intra-articular orthobiologics are common options in musculoskeletal and rehabilitation medicine, yet protocol variation remains a key challenge for clinicians. These findings provide practical guidance for regenerative care pathways:

  • Proven synergy: Combining the viscoelastic properties of HA with the bioactive growth factors in PRP offers clear additive therapeutic benefits.
  • Judicious resource allocation: Adding expensive cellular adjuncts like MSCs or supplemental ozone to PRP injections is currently unsupported by high-level comparative evidence.

Limitations

The total evidence network relied on a relatively small number of trials for the MSC and ozone arms, contributing to wide confidence intervals and lower statistical power for those comparisons. Additionally, heterogeneity in PRP preparation methods, dosing schedules, and patient follow-up intervals across the included studies underscores the need for standardized, long-term clinical trials.

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