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Outcomes were analyzed on an intention\u2010to\u2010treat basis with random\u2010effects models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 13 RCTs were included in the meta\u2010analysis. Compared with placebo, there was no significant difference in VAS for pain (mean difference [MD] 1.62, 95% confidence interval [CI \u20130.60 to 3.85), WOMAC pain score (MD 1.88, 95% CI \u20130.21 to 3.98), WOMAC function score (MD \u20130.67, 95% CI \u20136.54 to 5.19), or WOMAC stiffness score (MD 0.64, 95% CI \u20130.86 to 2.14) for MSCs. Moreover, the smallest treatment effect of VAS for pain, WOMAC pain score, WOMAC function score, and WOMAC stiffness score did not exceed the minimum clinically important difference (MCID). Additionally, there was no significant difference in percentage of patients crossing the MCID threshold between MSC and placebo groups for VAS for pain (relative risk [RR] 0.93, 95% CI 0.55 to 1.57) or WOMAC total score (RR 0.40, 95% CI 0.13 to 1.21). Compared with hyaluronic acid (HA), MSC injection was associated with significantly better improvement in VAS for pain (MD 2.00, 95% CI 0.94 to 3.07), WOMAC pain score (MD 4.58, 95% CI 0.49 to 8.67), WOMAC total score (MD 14.86, 95% CI 10.59 to 19.13), and WOMAC stiffness score (MD 1.85, 95% CI 0.02 to 3.69). However, the smallest treatment effect of VAS for pain, WOMAC pain score, WOMAC function score, and WOMAC stiffness score did not exceed the MCID. Moreover, there was no significant difference in percentage of patients crossing the MCID threshold between MSC and HA groups for WOMAC total score (RR 0.57, 95% CI 0.21 to 1.55). We also found that MSCs did not increase adverse events compared with HA and placebo.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Intra\u2010articular MSC injection was not found to be superior to placebo in pain relief and functional improvement for patients with symptomatic knee OA. However, additional direct testing and combination trials of different type of cells, doses, and number of injections of MSCs are required to further enhance clinical decision making for people with symptomatic knee OA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>I, meta\u2010analysis of level I studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1016\/j.arthro.2020.10.016","type":"journal-article","created":{"date-parts":[[2020,10,21]],"date-time":"2020-10-21T11:33:41Z","timestamp":1603280021000},"page":"340-358","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":57,"title":["Intra\u2010Articular Mesenchymal Stromal Cell Injections Are No Different From Placebo in the Treatment of Knee Osteoarthritis: A Systematic Review and Meta\u2010analysis of Randomized Controlled Trials"],"prefix":"10.1002","volume":"37","author":[{"given":"Wenli","family":"Dai","sequence":"first","affiliation":[{"name":"Institute of Sports Medicine Beijing Key Laboratory of Sports Injuries Peking University Third Hospital Beijing People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xi","family":"Leng","sequence":"additional","affiliation":[{"name":"Medical Imaging Center The First Affiliated Hospital of Guangzhou University of Chinese Medicine Guangdong People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery Nanfang Hospital Southern Medical University Guangdong People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhanjun","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery Nanfang Hospital Southern Medical University Guangdong People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin","family":"Cheng","sequence":"additional","affiliation":[{"name":"Institute of Sports Medicine Beijing Key Laboratory of Sports Injuries Peking University Third Hospital Beijing People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoqing","family":"Hu","sequence":"additional","affiliation":[{"name":"Institute of Sports Medicine Beijing Key Laboratory of Sports Injuries Peking University Third Hospital Beijing People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingfang","family":"Ao","sequence":"additional","affiliation":[{"name":"Institute of Sports Medicine Beijing Key Laboratory of Sports Injuries Peking University Third Hospital Beijing People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,10,21]]},"reference":[{"key":"e_1_2_3_2_2","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2013-204763"},{"key":"e_1_2_3_3_2","doi-asserted-by":"publisher","DOI":"10.1002\/art.11094"},{"key":"e_1_2_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)71086-2"},{"key":"e_1_2_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.berh.2014.01.004"},{"key":"e_1_2_3_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)60752-6"},{"key":"e_1_2_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)60243-2"},{"key":"e_1_2_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2017.12.016"},{"key":"e_1_2_3_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2019.05.043"},{"key":"e_1_2_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2017.09.023"},{"key":"e_1_2_3_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2014.01.003"},{"key":"e_1_2_3_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2014.11.031"},{"key":"e_1_2_3_13_2","article-title":"The cost\u2010effectiveness of platelet\u2010rich plasma compared with hyaluronic acid injections for the treatment of knee osteoarthritis","volume":"25","author":"Samuelson E.M.","year":"2020","journal-title":"Arthroscopy. 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