Intraosseous Injections Are Safe And Effective in Knee Osteoarthritis: A Systematic Review

PURPOSE: To evaluate clinical outcomes after intraosseous injection for knee osteoarthritis systematically with available clinical evidence. METHODS: A systematic search methodology of the PUBMED, EMBASE, and CINAHL databases was conducted in November 2020. The search workflow was in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The following inclusion criteria were adopted: clinical trials of any level of evidence, reporting clinical outcomes following intraosseous injections of bone substitutes or biologic agents, and mesenchymal stem cells or platelet-rich plasma into the knee as treatment modalities for osteoarthritis. Duplicate data and articles not written in English were excluded from this review. RESULTS: Six studies were identified and included in this review, with a total of 167 patients. Two studies used subchondroplasty CaP injections, while 4 studies used intraosseous injections of platelet-rich plasma. Two studies provided Level II evidence, 2 studies provided Level III evidence, and a further 2 provided Level IV evidence. Five out of 6 studies reported data using the visual analog scale, 4 studies used the Knee Injury and Osteoarthritis Outcome Score, while 3 studies used the Western Ontario and McMaster Universities Osteoarthritis Index. Clinical improvements in pain and functionality were documented in all trials, with only a few patients experiencing adverse events. CONCLUSION: Intraosseous injections for knee osteoarthritis are safe and effective. However, multiple pertinent variables such as safety, cost of treatment, and performance against placebos and other treatment modalities require further evaluation before intraosseous injections can be considered as standard treatment for patients presenting with osteoarthritis of the knee.