High tibial osteotomy combined with platelet-rich plasma for knee osteoarthritis: A Systematic review and Meta-analysis

Abstract Objective: To systematically review the clinical efficacy and safety of high tibial osteotomy combined with platelet-rich plasma in treating knee osteoarthritis, and provide evidence-based medical evidence for its effectiveness in treating knee osteoarthritis. Methods: Clinical studies of high tibial osteotomy combined with platelet-rich plasma for knee osteoarthritis, before June 2023, were searched in databases. Strictly screen out the literature that meets the inclusion criteria, extract the literature data information, and input it into RevMan5.4 for analysis. Results: 10 studies(12 controls) were included, with 625 patients. The results showed that, in general, VAS(MD=-0.53，95%CI(-0.76,-0.31), P＜0.00001), ROM(MD=7.24,95%CI(2.79,11.69), P=0.001), WOMAC(MD=-6.91,95%CI(-9.47,-4.34), P＜0.00001), cartilage recovery(cartilage thickness: MD=0.43, 95%CI(0.35, 0.51), P<0.00001; cartilage regeneration: RR=1.81, 95%CI(1.40, 2.33), P<0.00001; ICRS grade: RR=1.96, 95%CI(1.44, 2.66), P<0.0001), and Lysholm(MD=6.51, 95%CI(4.97, 8.04), P<0.00001) after PRP treatment had significant advantages compared with the control group. After treatment, there was no statistically significant difference of knee joint mechanical axes angles in platelet-rich plasma group compared with control group (FTA: MD=-0.29, 95%CI(-1.07, 0.49), P=0.47; MPTA: MD=0.19, 95%CI(-0.49, 0.88), P=0.58; PTS: MD=-0.12, 95%CI(-0.49, 0.25), P=0.53; KVA: MD=-0.30, 95%CI(-1.77, 1.17), P=0.69; WBL: MD=1.10, 95%CI(-0.89, 3.09), P=0.28). Conclusion: The results showed that in the treatment of KOA by HTO, the combined PRP group had better efficacy than other control groups, and had certain safety reliability.