Comparative Clinical Effectiveness of Intra-Articular Leukocyte-Rich Platelet-Rich Plasma and Hyaluronic Acid in Treating Knee Osteoarthritis Pain: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials.

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19 randomized controlled trials (RCTs) including 1771 patients with knee osteoarthritis (OA) were included in this systematic review and meta-analysis comparing intra-articular leukocyte-rich platelet-rich plasma (LR-PRP) with hyaluronic acid (HA). Pooled outcomes included pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total scores, WOMAC pain, physical function and stiffness scores, and adverse events. LR-PRP provided greater pain relief at 3 months, but this advantage was not maintained at 1, 6, or 12 months; meanwhile, WOMAC physical function and stiffness favoured LR-PRP at 12 months, while total WOMAC scores and adverse events were similar between groups. Overall, LR-PRP may provide selected longer-term functional benefits but did not demonstrate a consistent advantage over HA for pain management in knee OA.