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Bensa_2025_TandF_14712598.2025.2465833
Journal article

Corticosteroids, hyaluronic acid, platelet-rich plasma, and cell-based therapies for knee osteoarthritis - literature trends are shifting in the injectable treatments' evidence : a systematic review and expert opinion

  • Bensa, Alessandro ORCID Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland - Faculty of Biomedical Sciences, Università della Svizzera italiana, Switzerland
  • Bianco Prevot, Luca Residency Program in Orthopedics and Traumatology, University of Milan, Italy - Dipartimento di Ortopedia e Traumatologia, IRCCS Ospedale Galeazzi - S. Ambrogio, Milan, Italy
  • Moraca, Giacomo Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
  • Sangiorgio, Alessandro Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
  • Boffa, Angelo Dipartimento di Scienze Biomediche e Neuromotorie, Alma Mater Studiorum Università di Bologna, Italy
  • Filardo, Giuseppe ORCID Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland - Faculty of Biomedical Sciences, Università della Svizzera italiana, Switzerland
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  • 2025
Published in:
  • Expert Opinion on Biological Therapy. - 2025, vol. 25, no. 3, p. 309-318
Intra-articular
Knee
Osteoarthritis
Corticosteroids
Hyaluronic acid
Platelet-rich plasma
Cell-based therapies
English Introduction: The aim of this systematic review was to quantify the data available on corticosteroids (CS), hyaluronic acid, (HA), platelet-rich plasma (PRP), and cell-based therapies for knee osteoarthritis (OA) treatment. Methods: A literature search was conducted on PubMed, Cochrane, and Web of Science according to the PRISMA guidelines. Inclusion criteria: clinical studies of any level of evidence, written in English, evaluating the intra-articular use of CS, HA, PRP, or cell-based therapies for knee OA treatment. Results: The initial search identified 17,415 records. A total of 766 studies from 1959 were included. Of these, 401 were randomized controlled trials (RCTs), 110 comparative studies, and 255 case series, for a total of 75,834 patients. (11,245 treated with CS, 40,862 with HA, 16,174 with PRP, and 7,553 with cell- based therapies). The number of placebo-controlled RCTs remains limited and a negligible percentage of studies investigated possible disease-modifying effects of these treatments for knee OA. Conclusions: The evidence on injective knee OA treatments is increasing at different speeds with a more rapidly growing literature focusing on orthobiologics. Currently, HA has the largest evidence, followed by PRP that recently surpassed the number of studies evaluating CS. Cell-based therapies are also growing rapidly, although the number of studies is still lower. The rapid literature shift toward orthobiologics urges an update in societies’ guidelines to align with the new body of evidence on knee OA treatments.
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Language
  • English
Classification
Medicine
License
CC BY-NC-ND
Open access status
gold
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Persistent URL
https://n2t.net/ark:/12658/srd1335447
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