ReviewJournal of orthopaedic surgery and research2026
Biologics or surgery for moderate knee osteoarthritis? a patient-centered framework for short-term relief and long-term outcomes.
Review in Journal of orthopaedic surgery and research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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5 authors.
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Abstract
purposeTo provide a narrative synthesis comparing clinical outcomes, durability, and patient-specific suitability of autologous biologic therapies (platelet-rich plasma [PRP], bone marrow aspirate concentrate [BMAC]) versus non-TKA surgical strategies (high tibial osteotomy [HTO], unicompartmental knee arthroplasty [UKA]) in patients with moderate knee osteoarthritis (Kellgren-Lawrence grade 2-3).
methodsA structured literature search was conducted in PubMed, Scopus, and Web of Science (January 2010-March 2024). Priority was given to prospective cohort studies, randomized controlled trials, and comparative studies involving KL grade 2-3 patients. Evidence was synthesized qualitatively, focusing on pain, function, durability, complications, and cost-effectiveness.
resultsBiologic therapies provide rapid pain relief within 3-6 months (mean VAS/WOMAC reduction: -2.6 to - 5.8 points) but show attenuation beyond 18-24 months, particularly in KL3 disease. BMAC demonstrates superior short-term outcomes compared to PRP (WOMAC mean difference - 5.8, p = 0.03). Surgical interventions exhibit slower initial improvement but superior durability, with 5-year survivorship of 92% for UKA and 85% for HTO. Complication rates are low for biologics (< 1% major) but higher for surgery (HTO 5.2%, UKA 3.8%). Cost-effectiveness remains favorable for all interventions (<$50,000/QALY). KL2 patients respond well to biologics, while KL3 patients with malalignment derive greater benefit from surgery.
conclusionsManagement of moderate knee OA is best guided by a severity-stratified, patient-centered framework. Biologic therapies may be suitable for earlier-stage disease or for patients seeking minimally invasive, short-term symptom relief, while surgical interventions represent more durable options for patients with advanced degeneration or biomechanical imbalance. Treatment decisions should prioritize patient characteristics, disease stage, values, and expectations rather than implying a hierarchical superiority of one modality over another. LEVEL OF EVIDENCE: Narrative Review - Level V.
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