Intraosseous Infiltration of Platelet-Rich Plasma for Knee Osteoarthritis: A Systematic Review of Literature and Limited Meta-analysis.

Background: The role of subchondral bone as a key mediator in pathogenesis of osteoarthritis (OA) is emerging and various injectable modalities are being tried to address the subchondral pathology. Intraosseous (IO) infiltrations of PRP is biological way of addressing the pathology. This review aimed to explore the role of IO PRP in OA knees. Methods: A systematic literature search was conducted on the electronic databases of PubMed, Embase, Scopus, Web of Science and Ovid for relevant articles on IO PRP with a predefined search strategy. Data from eligible studies were extracted and was analyzed. Results: There were only five studies on the study topic which included 112 patients (112 knees) who received IO PRP injection. IO PRP was associated with significant improvements in VAS, KOOS and WOMAC scores. The most commonly reported complication was pain at injection site. Meta-analysis revealed that combined intraarticular (IA) and IO PRP were associated with significantly better WOMAC scores, compared to only IA PRP. However, VAS and KOOS scores were equivocal. Conclusion: IO PRP infiltration for OA knees is safe and effective and results in improved patient-reported outcome scores based on the current limited literature. However, its added advantage over only IA PRP is not well established and clear due to limited available published data.