For management of knee osteoarthritis, hyaluronic acid, bone marrow aspirate concentrate, and leukocyte rich platelet rich plasma injections are safe choices. They offer favorable clinical outcomes after twelve months when compared to the outcomes preceding the intervention.

This prospective, single-center, clinical study was carried out for directly comparing the clinical effects of knee injections of platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC), or hyaluronic acid (HA) for osteoarthritis management.

The study enrolled 175 people having knee pain and osteoarthritis and randomly segregated them to get   HA (n=30), BMAC (n=111), and PRP injection (n=34) in the knee. For establishing baseline values at one, three, six, nine, and twelve months, Visual Analog Scale (VAS), International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were utilized. Reporting of all the adverse effects was done.

In terms of gender, Kellgren-Lawrence grade, body mass index, age, no differences were noted between these groups. No severe adverse effects were noted. The mean pain scores following 3, 7, 14, and 21 days depicted considerable differences between the arms with a drop of VAS score in all the arms. However, a difference was noted in the BMAC arm when compared to the other arms (Figure 1).

High clinically meaningful differences were witnessed between the baseline scores and those following twelve months in IKDC scores, KOOS pain, WOMAC, and KOOS overall.  Furthermore, differences were noted between these scores in the BMAC arm when compared to other arms, with the exception of the PRP arm in WOMAC and the partial IKDC score. No differences were noted between PRP and HA arms, even though PRP demonstrated a greater level of clinical improvements.

Regarding clinical improvements in knee osteoarthritis, BMAC can be better when compared to PRP and HA up to twelve months. PRP offered better outcomes when compared to HA during the observation period. However, more trials and high-quality studies are warranted for direct correlative conclusions.