{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T11:54:16Z","timestamp":1789732456225,"version":"4.0.1"},"reference-count":15,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2020,1,3]],"date-time":"2020-01-03T00:00:00Z","timestamp":1578009600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,1,3]],"date-time":"2020-01-03T00:00:00Z","timestamp":1578009600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Flexion Therapeutics"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee Surg Sports Traumatol Arthrosc"],"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>There are a number of developments in intra-articular therapies that have been determined to be differentiating factors within the classes of treatments. This study evaluated the efficacy and safety of intra-articular treatments of primary knee osteoarthritis in the short term (3\u00a0months follow-up), using a network meta-analysis design, while taking within-class differentiating factors into consideration.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A literature search of MEDLINE (through OVID), EMBASE (through OVID), Cochrane Central Register of Controlled Trials for all trials comparing intra-articular therapies was conducted on November 12, 2018. The treatments assessed were high molecular weight and low molecular weight hyaluronic acid injections, extended-release corticosteroids, standard-release corticosteroids, platelet-rich plasma, and saline. A frequentist network meta-analysis was conducted for each outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Sixty-four articles (9710 patients) met the inclusion criteria. High molecular weight hyaluronic acid (\u2212\u00a00.53, 95% CI \u2212\u00a00.81 to \u2212\u00a00.25) and PRP (\u2212\u00a00.79, 95% CI \u2212\u00a01.32 to \u2212\u00a00.26) were the only treatments with a confidence interval that lay completely above the MID threshold; however, PRP results varied within sensitivity analyses. For the function analysis, high molecular weight hyaluronic acid (SMD \u2212\u00a00.76, 95% CI \u2212\u00a01.30 to \u2212\u00a00.22) was the only treatment with a confidence interval entirely above the MID. Extended-release corticosteroid demonstrated a possible benefit in functional improvement (SMD \u2212\u00a00.98, 95% CI \u2212\u00a01.79 to \u2212\u00a00.17) compared to that of standard-release corticosteroid (SMD \u2212\u00a00.14, 95% CI \u2212\u00a00.72 to 0.44).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>High molecular weight HA was the only treatment to surpass the MID for both pain and function outcomes. Extended-release corticosteroids may provide additional clinical benefit over standard-release corticosteroids. Platelet-rich plasma demonstrated possibly beneficial results; however, wide confidence intervals and sensitivity analyses made the conclusions of efficacy uncertain.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>Level 1. Systematic review of level 1 evidence.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-019-05763-1","type":"journal-article","created":{"date-parts":[[2020,1,3]],"date-time":"2020-01-03T05:09:55Z","timestamp":1578028195000},"page":"3031-3039","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":58,"title":["Differentiating factors of intra-articular injectables have a meaningful impact on knee osteoarthritis outcomes: a network meta-analysis"],"prefix":"10.1002","volume":"28","author":[{"given":"Mark","family":"Phillips","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Vannabouathong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tahira","family":"Devji","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahil","family":"Patel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zoya","family":"Gomes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashaka","family":"Patel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mykaelah","family":"Dixon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohit","family":"Bhandari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,1,3]]},"reference":[{"key":"5763_CR1","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1016\/j.semarthrit.2016.04.003","volume":"46","author":"RD Altman","year":"2016","unstructured":"Altman RD, Devji T, Bhandari M, Fierlinger A, Niazi F, Christensen R (2016) Clinical benefit of intra-articular saline as a comparator in clinical trials of knee osteoarthritis treatments: a systematic review and meta-analysis of randomized trials. 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Has received Honoraria from Sanofi and Pendopharm, unrelated to this project. Chris Vannabouathong: Received wages to compensate for the time and resources used to develop this manuscript. No other conflicts of interest to disclose. Tahira Devji: Has received Honoraria from Sanofi and Pendopharm, unrelated to this project. Rahil Patel: No conflicts of interest to disclose. Zoya Gomes: No conflicts of interest to disclose. Ashaka Patel: No conflicts of interest to disclose. Mykaelah Dixon: No conflicts of interest to disclose. Mohit Bhandari: Has received research funding from Flexion, Sanofi, Anika, Ferring, Stryker, DJO, Acumed and Titan Spine.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This article does not contain any studies with human participants performed by any of the authors.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}