Comparative efficacy of platelet-rich plasma monotherapy versus combination therapies for knee osteoarthritis: a systematic review and network meta-analysis

BACKGROUND: ) provides additional clinical benefit remains unclear. We conducted a systematic review and network meta-analysis (NMA) to compare the efficacy of PRP monotherapy with these three PRP-based combination strategies. METHODS: in adults with KOA. Two reviewers independently performed study selection, data extraction, and risk of bias assessment using the Cochrane RoB 2 tool. The primary outcomes were changes in WOMAC total score and VAS pain score. A random-effects NMA was conducted within a frequentist framework in Stata 17.0. Treatment rankings were calculated using surface under the cumulative ranking curve (SUCRA) values. RESULTS: (MD = - 0.15, 95% CI - 1.87 to 1.57) did not differ significantly from PRP alone. SUCRA values ranked PRP + HA highest for VAS pain and second for WOMAC function. No significant publication bias was detected. CONCLUSIONS: provides any additional benefit. Standardized, large-scale RCTs with longer follow-up are needed to clarify the role of these emerging combinations.