Subchondral Knee Injections: A Comprehensive Systematic Review of Current Clinical Outcomes, Safety, and Arthroplasty Delay

Relatively higher-quality human studies compared with other topics in this database, e.g. multiple RCTs or systematic reviews. This does not mean it is standard or approved care.

• Level A · Stronger Clinical Evidence
• Level B · Emerging clinical evidence with positive signals
• Level C · Early human research exploring benefits
• Level D · Scientific groundwork from lab and animal studies
• Emerging · Emerging topic under active research

Abstract (original English)

IntroductionOsteoarthritis is considered a whole-joint disease involving subchondral bone. Intraosseous therapies such as calcium phosphate (CaP), platelet-rich plasma (PRP), and mesenchymal stem cells (MSCs) offer joint-preserving options for knee osteoarthritis (OA).PurposeTo critically appraise and update the clinical evidence on intraosseous injections for knee osteoarthritis, focusing on safety, functional outcomes, need for retreatment, and conversion rates to total knee arthroplasty (TKA).MethodsA systematic review of PubMed, Embase, and Cochrane was conducted following PRISMA guidelines and PROSPERO registration (CRD420251104989). Clinical studies reporting outcomes of intraosseous injections with CaP, PRP, or MSCs for knee osteoarthritis with ≥5 patients and ≥6 months of follow-up were included. Methodological quality was assessed using the modified Coleman Methodology Score and Cochrane Risk of Bias 2.0 tool.ResultsTwenty-four studies involving 1,109 patients (mean age, 55 years; mean follow-up, 38 months) met inclusion criteria: 10 on CaP, 6 on PRP, and 8 on MSCs. Five were randomized controlled trials (RCTs). Most studies reported significant improvements in pain and function. CaP injection outcomes were variable, with TKA conversion rates ranging from 1.3% to 45%. PRP and MSCs studies showed favorable safety profiles and lower conversion rates. Long-term MSCs data

Evidence level

Relatively higher-quality human studies compared with other topics in this database, e.g. multiple RCTs or systematic reviews. This does not mean it is standard or approved care.

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