Evidence map›Paper›PMID 31897550›Full record

SynthesisKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2020

Differentiating factors of intra-articular injectables have a meaningful impact on knee osteoarthritis outcomes: a network meta-analysis.

Mark Phillips, Christopher Vannabouathong, Tahira Devji, Rahil Patel, Zoya Gomes, Ashaka Patel, Mykaelah Dixon, Mohit Bhandari

Abstract readSystematic ReviewNetwork Meta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 38 papers, 12 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
38citing papers in PubMed, 12 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

38 citing papers in PubMed, 12 syntheses or guidelines pooled it.

  1. Pooled it
  2. Intra-articular hyaluronic acid injections for hip osteoarthritis: a level I systematic review.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2025
    Pooled it
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  13. Trial
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  15. Review
  16. Non-Biologic Injections in Sports Medicine.Current reviews in musculoskeletal medicine · 2026
    Review
  17. Article
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  19. Article
  20. Spin and reporting bias in the use of platelet-rich plasma for the treatment of knee osteoarthritis.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2025
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Mark PhillipsDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada. phillimr@mcmaster.ca.
Christopher VannabouathongOrthoEvidence Inc., Burlington, ON, Canada.
Tahira DevjiDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Rahil PatelFaculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
Zoya GomesFaculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
Ashaka PatelFaculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
Mykaelah DixonFaculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
Mohit BhandariDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeThere are a number of developments in intra-articular therapies that have been determined to be differentiating factors within the classes of treatments. This study evaluated the efficacy and safety of intra-articular treatments of primary knee osteoarthritis in the short term (3 months follow-up), using a network meta-analysis design, while taking within-class differentiating factors into consideration.

methodsA literature search of MEDLINE (through OVID), EMBASE (through OVID), Cochrane Central Register of Controlled Trials for all trials comparing intra-articular therapies was conducted on November 12, 2018. The treatments assessed were high molecular weight and low molecular weight hyaluronic acid injections, extended-release corticosteroids, standard-release corticosteroids, platelet-rich plasma, and saline. A frequentist network meta-analysis was conducted for each outcome.

resultsSixty-four articles (9710 patients) met the inclusion criteria. High molecular weight hyaluronic acid (- 0.53, 95% CI - 0.81 to - 0.25) and PRP (- 0.79, 95% CI - 1.32 to - 0.26) were the only treatments with a confidence interval that lay completely above the MID threshold; however, PRP results varied within sensitivity analyses. For the function analysis, high molecular weight hyaluronic acid (SMD - 0.76, 95% CI - 1.30 to - 0.22) was the only treatment with a confidence interval entirely above the MID. Extended-release corticosteroid demonstrated a possible benefit in functional improvement (SMD - 0.98, 95% CI - 1.79 to - 0.17) compared to that of standard-release corticosteroid (SMD - 0.14, 95% CI - 0.72 to 0.44).

conclusionHigh molecular weight HA was the only treatment to surpass the MID for both pain and function outcomes. Extended-release corticosteroids may provide additional clinical benefit over standard-release corticosteroids. Platelet-rich plasma demonstrated possibly beneficial results; however, wide confidence intervals and sensitivity analyses made the conclusions of efficacy uncertain. LEVEL OF EVIDENCE: Level 1. Systematic review of level 1 evidence.

Indexed as

Delayed-Action PreparationsGlucocorticoidsHumansHyaluronic AcidInjections, Intra-ArticularOsteoarthritis, KneePlatelet-Rich PlasmaSaline SolutionDelayed-Action PreparationsGlucocorticoidsHyaluronic AcidSaline Solution

Identifiers

PMID31897550
PMCPMC7471203

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.