The effect of combined platelet-rich plasma and exercise on pain and function in knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials.

Abstract

This meta-analysis aimed to synthesize existing research evaluating short-term (<6 months) and long-term (≥6 months) effects of post-platelet-rich plasma (PRP) exercise on pain and function, compared to exercise alone or PRP alone in treatment of knee osteoarthritis (OA). Six databases were searched from inception to October 2025. Randomized controlled trials (RCTs) comparing post-PRP exercise therapy with exercise alone or PRP alone in knee OA were included. Methodological quality and risk of bias were assessed using PEDro and RoB-2, and certainty of evidence was assessed using GRADE. Six RCTs with 314 individuals were included. Post-PRP exercise therapy reduced pain compared with exercise alone (short-term MD: -2.69, <i>p</i> < 0.00001; long-term SMD: -0.65, <i>p</i> = 0.008) and PRP alone (short-term MD: -2.00, <i>p</i> < 0.00001; long-term SMD: -1.24, <i>p</i> = 0.02). Functional improvement was greater than PRP alone in short term (MD: -2.09, <i>p</i> < 0.0001) and greater than exercise alone in long term (MD: -1.85, <i>p</i> = 0.02). Although post-PRP exercise therapy shows statistically significant benefits for pain and function, these findings should be interpreted with caution due to moderate methodological quality, high risk of bias, and low to very low certainty of evidence. While pain reductions exceed the minimum clinically important difference, functional improvements do not, thereby limiting conclusions regarding clinical efficacy. CRD420251146880.