A recent systematic review showed that non-operative treatment options are effective for management of pain in the knee osteoarthritis. Out of all treatment choices, platelet rich plasma and intra-articular hyaluronic acid formulations exhibited the most reliable evidence as compared to other approaches.

Guidelines recommending the use of various nonoperative treatments for knee osteoarthritis patients remain inconsistent. The role of non-operative procedures in knee arthritis management is still unclear. The present review and meta-analysis was conducted to compare various medical devices or pharmacological treatments for knee osteoarthritis and also evaluated intra-articular placebo consequences on intra-articular injection interventions.

The studies involving comparison of meta-analyses of medical device or pharmacological interventions role vs control for treating knee pain were searched through Embase, PubMed and MEDLINE by 30 May 2017. The screening of reports for eligibility and data extraction was done by two reviewers independently. The standardised mean difference (SMD) scale showed effect estimates. These SMD scores then compared with the threshold to evaluate the clinical importance of 0.50 SD unit. 

A total of 10 meta-analyses containing 19 different effect sizes for pain were searched. Numerous modalities like orthotic devices, topical and oral NSAIDs, electrical interventions, intra-articular injections and dietary supplements ranges SMD values from 0.08 to 0.79. As compared to controls, 17 treatments exhibited remarkable pain reduction. As per intra-articular placebo effect, the high molecular weight intra-articular hyaluronic acid and intra-articular platelet-rich plasma presented highest effect estimates. 

Out of these, high molecular weight intra-articular hyaluronic acid showed most precise effect, when judged as per threshold for clinical importance (0.50 SD). On the other hand, platelet-rich plasma exhibited highest uncertain precision. The intra-articular hyaluronic acid formulations showed the most robust evidence for clinical efficacy and treatment effects.