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Expert Opinion on Biological Therapy Volume 14, 2014 - Issue 5
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Knee osteoarthritis: hyaluronic acid, platelet-rich plasma or both in association?

Isabel AndiaCruces University Hospital, BioCruces Health Research Institute, Regenerative Medicine Laboratory, 48903 Barakaldo, [email protected]
, PhD &
Michele AbateUniversity G. D'Annunzio, Department of Medicine and Science of Aging, Chieti-Pescara, Chieti Scalo, Italy
, MD PhD
Pages 635-649 | Published online: 17 Feb 2014

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Hua-feng Zhang, Chen-guang Wang, Hui Li, Yu-ting Huang & Zhi-jun Li. (2018) Intra-articular platelet-rich plasma versus hyaluronic acid in the treatment of knee osteoarthritis: a meta-analysis. Drug Design, Development and Therapy 12, pages 445-453.
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Szu-Hsuan Chen, Ta-Shen Kuan, Mu-Jung Kao, Wei-Ting Wu & Li-Wei Chou. (2016) Clinical effectiveness in severe knee osteoarthritis after intra-articular platelet-rich plasma therapy in association with hyaluronic acid injection: three case reports. Clinical Interventions in Aging 11, pages 1213-1219.
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Isabel Andia & Michele Abate. (2015) Platelet-rich plasma in the treatment of skeletal muscle injuries. Expert Opinion on Biological Therapy 15:7, pages 987-999.
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Articles from other publishers (52)

Abhijith Murali, Insharah Khan & Smriti Tiwari. (2024) Navigating the treatment landscape: Choosing between platelet-rich plasma (PRP) and hyaluronic acid (HA) for knee osteoarthritis management – A narrative review. Journal of Orthopaedic Reports 3:1, pages 100248.
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Eric A. Branch, Joshua J. Cook, Achraf Cohen, Hillary Plummer, Alireza Emami, Jessica Truett & Adam W. Anz. (2023) Platelet-rich plasma is similar to platelet-rich plasma plus hyaluronic acid for the treatment of knee osteoarthritis at 2 years: a randomized controlled trial. Journal of Cartilage & Joint Preservation 3:4, pages 100129.
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Md Al Amin Howlader, Ahmad Almigdad, Jannatul Ferdousy Urmi & Hassan Ibrahim. (2023) Efficacy and Safety of Hyaluronic Acid and Platelet-Rich Plasma Combination Therapy Versus Platelet-Rich Plasma Alone in Treating Knee Osteoarthritis: A Systematic Review. Cureus.
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Yu-Ying Lin, Che-Yung Kuan, Chia-Tien Chang, Ming-Hsi Chuang, Wan-Sin Syu, Kai-Ling Zhang, Chia-Hsin Lee, Po-Cheng Lin, Guo-Chung Dong & Feng-Huei Lin. (2023) 3D-Cultured Adipose-Derived Stem Cell Spheres Using Calcium-Alginate Scaffolds for Osteoarthritis Treatment in a Mono-Iodoacetate-Induced Rat Model. International Journal of Molecular Sciences 24:8, pages 7062.
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Bruna Alice G. de Melo, Andrea A.M. Shimojo, Carla G. França, Ângela Cristina M. Luzo, José Fabio S.D. Lana & Maria Helena A. Santana. 2023. Nanotechnology and Regenerative Medicine. Nanotechnology and Regenerative Medicine 315 347 .
Qing Zhang, Tuodong Liu, Yuan Gu, Yongquan Gao & Jiangdong Ni. (2022) Efficacy and safety of platelet-rich plasma combined with hyaluronic acid versus platelet-rich plasma alone for knee osteoarthritis: a systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research 17:1.
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Hung-Ya Huang, Chien-Wei Hsu, Guan-Chyun Lin, Huey-Shyan Lin, Yi-Jiun Chou, I-Hsiu Liou & Shu-Fen Sun. (2022) Comparing efficacy of a single intraarticular injection of platelet-rich plasma (PRP) combined with different hyaluronans for knee osteoarthritis: a randomized-controlled clinical trial. BMC Musculoskeletal Disorders 23:1.
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Farshad Nouri, Marzieh Babaee, Parya Peydayesh, Hadi Esmaily & Seyed Ahmad Raeissadat. (2022) Comparison between the effects of ultrasound guided intra-articular injections of platelet-rich plasma (PRP), high molecular weight hyaluronic acid, and their combination in hip osteoarthritis: a randomized clinical trial. BMC Musculoskeletal Disorders 23:1.
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Huan Wang, Jun Shu, Chengfei Zhang, Yang Wang, Rongxing Shi, Fan Yang & Xuezhang Tang. (2022) Extracellular Vesicle-Mediated miR-150-3p Delivery in Joint Homeostasis: A Potential Treatment for Osteoarthritis?. Cells 11:17, pages 2766.
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Ming Li, Hong Han, Liu Chen & Haohan Li. (2022) Platelet-rich plasma contributes to chondroprotection by repairing mitochondrial function via AMPK/NF-κB signaling in osteoarthritic chondrocytes. Tissue and Cell 77, pages 101830.
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Yung-Tsan Wu, Tsung-Ying Li, Kuei-Chen Lee, King Hei Stanley Lam, Chih-Ya Chang, Cheng-Kuang Chang & Liang-Cheng Chen. (2022) Efficacy of a Novel Intra-Articular Administration of Platelet-Rich Plasma One-Week Prior to Hyaluronic Acid versus Platelet-Rich Plasma Alone in Knee Osteoarthritis: A Prospective, Randomized, Double-Blind, Controlled Trial. Journal of Clinical Medicine 11:11, pages 3241.
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Martina Di Francesco, Agnese Fragassi, Martina Pannuzzo, Miguel Ferreira, Sayanti Brahmachari & Paolo Decuzzi. (2022) Management of osteoarthritis: From drug molecules to nano/ micromedicines . WIREs Nanomedicine and Nanobiotechnology 14:3.
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Michael R. Baria, W. Kelton Vasileff, James Borchers, Alex DiBartola, David C. Flanigan, Evan Plunkett & Robert A. Magnussen. (2021) Treating Knee Osteoarthritis With Platelet-Rich Plasma and Hyaluronic Acid Combination Therapy: A Systematic Review. The American Journal of Sports Medicine 50:1, pages 273-281.
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Angeline Ai Ling Aw, Jun Jie Leeu, Xinyu Tao & Hamid Rahmatullah Bin Abd Razak. (2021) Comparing the efficacy of dual Platelet-Rich Plasma (PRP) and Hyaluronic Acid (HA) therapy with PRP-alone therapy in the treatment of knee osteoarthritis: a systematic review and meta-analysis. Journal of Experimental Orthopaedics 8:1.
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Theofilos Karasavvidis, Trifon Totlis, Ron Gilat & Brian J. Cole. (2021) Platelet-Rich Plasma Combined With Hyaluronic Acid Improves Pain and Function Compared With Hyaluronic Acid Alone in Knee Osteoarthritis: A Systematic Review and Meta-analysis. Arthroscopy: The Journal of Arthroscopic & Related Surgery 37:4, pages 1277-1287.e1.
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Shu-Fen Sun, Guan-Chyun Lin, Chien-Wei Hsu, Huey-Shyan Lin, I.-H.siu Liou & Shin-Yi Wu. (2021) Comparing efficacy of intraarticular single crosslinked Hyaluronan (HYAJOINT Plus) and platelet-rich plasma (PRP) versus PRP alone for treating knee osteoarthritis. Scientific Reports 11:1.
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Jeffrey N. WeissJeffrey N. Weiss. 2021. Orthopedic Stem Cell Surgery. Orthopedic Stem Cell Surgery 65 72 .
Jinlong Zhao, Hetao Huang, Guihong Liang, Ling-feng Zeng, Weiyi Yang & Jun Liu. (2020) Effects and safety of the combination of platelet-rich plasma (PRP) and hyaluronic acid (HA) in the treatment of knee osteoarthritis: a systematic review and meta-analysis. BMC Musculoskeletal Disorders 21:1.
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Gustavo Perrone, Yael Lastra, Camilo González, Nicolás Caggiano, Rubén Giménez, Román Pareja & Emilio De Simone. (2020) Treatment With Platelet Lysate Inhibits Proteases of Synovial Fluid in Equines With Osteoarthritis. Journal of Equine Veterinary Science 88, pages 102952.
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Erminia Mariani & Lia Pulsatelli. (2020) Platelet Concentrates in Musculoskeletal Medicine. International Journal of Molecular Sciences 21:4, pages 1328.
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Luciano A. Rossi, Nicolás S. Piuzzi & Shane A. Shapiro. (2020) Glenohumeral Osteoarthritis: The Role for Orthobiologic Therapies. JBJS Reviews 8:2, pages e0075-e0075.
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Gloria María Pontes-Quero, Luis García-Fernández, María Rosa Aguilar, Julio San Román, Juan Pérez Cano & Blanca Vázquez-Lasa. (2019) Active viscosupplements for osteoarthritis treatment. Seminars in Arthritis and Rheumatism 49:2, pages 171-183.
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G. A. Airapetov, N. V. Zagorodniy & A. A. Vorotnikov. (2019) Experimental method replacement of the osteo-chondral defects of the large joints (first results). Medical Herald of the South of Russia 10:2, pages 71-76.
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Michaela Kopka, Brendan Sheehan, Ryan Degen, Ivan Wong, Laurie Hiemstra, Olufemi Ayeni, Alan Getgood, Cole Beavis, Monika Volesky, Ross Outerbridge & Bogdan Matache. (2019) Arthroscopy Association of Canada Position Statement on Intra-articular Injections for Knee Osteoarthritis. Orthopaedic Journal of Sports Medicine 7:7, pages 232596711986011.
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Georgii Alexandrovich Airapetov, Oshozimhede Emeghomhe Iyalomhe & Faeren Matilda Adzege. (2019) Replacement of osteochondral defect of large joints: An experimental model in sheep. Journal of Orthopaedics 16:4, pages 284-287.
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Georgii Alexandrovich Airapetov, Oshozimhede Emeghomhe Iyalomhe & Faeren Matilda Adzege. (2019) Replacement of osteochondral defect of large joints: An experimental model in sheep. Journal of Orthopaedics 16:4, pages 308-311.
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Nahla M. Gaballa, Yassir A. Mohammed, Lamiaa M. Kamel & Heba M. Mahgoub. (2019) Therapeutic efficacy of intra-articular injection of platelet–rich plasma and ozone therapy in patients with primary knee osteoarthritis. The Egyptian Rheumatologist 41:3, pages 183-187.
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Farnad Imani & Vikram B. Patel. (2019) Therapeutic Challenges for Knee Osteoarthritis. Anesthesiology and Pain Medicine 9:3.
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N. V. Zagorodniy, A. A. Vorotnikov, G. A. Airapetov & G. A. Saneeva. (2019) Experimental and clinical aspects of combined method of replacement osteochondral defects of the knee. N.N. Priorov Journal of Traumatology and Orthopedics 26:2, pages 24-31.
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Tsung‐Ying Li, Yung‐Tsan Wu, Liang‐Cheng Chen, Shin‐Nan Cheng, Ru‐Yu Pan & Yeu‐Chin Chen. (2019) An exploratory comparison of single intra‐articular injection of platelet‐rich plasma vs hyaluronic acid in treatment of haemophilic arthropathy of the knee. Haemophilia 25:3, pages 484-492.
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Carlota Suárez-Barrio, Jaime Etxebarria, Raquel Hernáez-Moya, Marina del Val-Alonso, Maddalen Rodriguez-Astigarraga, Arantza Urkaregi, Vanesa Freire, María-Celia Morales, Juan Durán, Marta Vicario, Irene Molina, Rocío Herrero-Vanrell & Noelia Andollo. (2019) Hyaluronic Acid Combined with Serum Rich in Growth Factors in Corneal Epithelial Defects. International Journal of Molecular Sciences 20:7, pages 1655.
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Ronald E. Delanois, Jennifer I. Etcheson, Nipun Sodhi, Ralph F. HennIIIIII, Chukwuweike U. Gwam, Nicole E. George & Michael A. Mont. (2019) Biologic Therapies for the Treatment of Knee Osteoarthritis. The Journal of Arthroplasty 34:4, pages 801-813.
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YU CAI, ZHENXING SUN, BOKAI LIAO, ZHANQIANG SONG, TING XIAO & PENGFEI ZHU. (2019) Sodium Hyaluronate and Platelet-Rich Plasma for Partial-Thickness Rotator Cuff Tears. Medicine & Science in Sports & Exercise 51:2, pages 227-233.
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Thierry Pauyo & James P. Bradley. 2019. Biologics in Orthopaedic Surgery. Biologics in Orthopaedic Surgery 101 104 .
Alice Roffi, Norimasa Nakamura, Mikel Sanchez, Magali Cucchiarini & Giuseppe Filardo. (2018) Injectable Systems for Intra-Articular Delivery of Mesenchymal Stromal Cells for Cartilage Treatment: A Systematic Review of Preclinical and Clinical Evidence. International Journal of Molecular Sciences 19:11, pages 3322.
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Krishnaiah Kurapati, Sanjay Tapadia, Madhusudhan Rao, Kavitha Anbarasu, Vinod Kumar Verma & Syed Sultan Beevi. (2018) Efficacy of Intra-Articular Injection of Platelet Rich Plasma and Hyaluronic Acid in Early Knee Osteoarthritis – Case Series. European Journal of Molecular and Clinical Medicine 5:1, pages 30-36.
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Jorge Chahla & Bert R. Mandelbaum. (2018) Biological Treatment for Osteoarthritis of the Knee: Moving from Bench to Bedside—Current Practical Concepts. Arthroscopy: The Journal of Arthroscopic & Related Surgery 34:5, pages 1719-1729.
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Isabel Andia & Michele Abate. (2017) Platelet-rich plasma: combinational treatment modalities for musculoskeletal conditions. Frontiers of Medicine 12:2, pages 139-152.
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Mayssam Moussa, Daniel Lajeunesse, George Hilal, Oula El Atat, Gaby Haykal, Rim Serhal, Antonio Chalhoub, Charbel Khalil & Nada Alaaeddine. (2017) Platelet rich plasma (PRP) induces chondroprotection via increasing autophagy, anti-inflammatory markers, and decreasing apoptosis in human osteoarthritic cartilage. Experimental Cell Research 352:1, pages 146-156.
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Mandeep S. Dhillon, Sandeep Patel & Rakesh John. (2017) PRP in OA knee – update, current confusions and future options. SICOT-J 3, pages 27.
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Sandeep Patel. (2016) Platelet-rich Plasma in Osteoarthritis Knee: Status Report. Journal of Postgraduate Medicine, Education and Research 50:3, pages 0-0.
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Dante Dallari, Matilde Tschon, Giacomo Sabbioni & Gianluca Giavaresi. (2016) PRP and HA for Hip Osteoarthritis: Response. The American Journal of Sports Medicine 44:9, pages NP44-NP46.
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Sandeep Patel, Mandeep S. Dhillon & Tungish Bansal. (2016) PRP and HA for Hip Osteoarthritis: Letter to the Editor. The American Journal of Sports Medicine 44:9, pages NP44-NP44.
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Fabrizio Russo, Matteo D?Este, Gianluca Vadal?Caterina Cattani, Rocco Papalia, Mauro Alini & Vincenzo Denaro. (2016) Platelet Rich Plasma and Hyaluronic Acid Blend for the Treatment of Osteoarthritis: Rheological and Biological Evaluation. PLOS ONE 11:6, pages e0157048.
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Vincenzo Salini, Andrea Pantalone, Daniele Vanni & Michele Abate. 2016. Arthroscopy and Sport Injuries. Arthroscopy and Sport Injuries 433 437 .
Diana L. Ríos, Catalina López, María E. Álvarez, Ismael J. Samudio & Jorge U. Carmona. (2015) Effects over time of two platelet gel supernatants on growth factor, cytokine and hyaluronan concentrations in normal synovial membrane explants challenged with lipopolysaccharide. BMC Musculoskeletal Disorders 16:1.
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Michele Abate, Sandra Verna, Cosima Schiavone, Patrizia Di Gregorio & Vincenzo Salini. (2015) Efficacy and safety profile of a compound composed of platelet-rich plasma and hyaluronic acid in the treatment for knee osteoarthritis (preliminary results). European Journal of Orthopaedic Surgery & Traumatology 25:8, pages 1321-1326.
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Mandeep S. Dhillon & Sandeep Patel. (2015) Role of platelet rich plasma in early osteoarthritis of knee. Journal of Arthroscopy and Joint Surgery 2:2, pages 55-56.
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Antonio Marmotti, Roberto Rossi, Filippo Castoldi, Eliana Roveda, Gianni Michielon & Giuseppe M. Peretti. (2015) PRP and Articular Cartilage: A Clinical Update. BioMed Research International 2015, pages 1-19.
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Dmitri Souzdalnitski, Samer N. Narouze, Imanuel R. Lerman & Aaron Calodney. (2015) Platelet-rich plasma injections for knee osteoarthritis: Systematic review of duration of clinical benefit. Techniques in Regional Anesthesia and Pain Management 19:1-2, pages 67-72.
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Sowmya Viswanathan, Jesse Wolfstadt, Jaskarndip Chahal & Alejandro Gómez-Aristizábal. 2015. Osteoarthritis. Osteoarthritis 235 255 .
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