Intra-articular interventions in osteoarthritis: Navigating the landscape of hyaluronic acid, mesenchymal stem cells, and platelet-rich plasma

Table 2 Comparison between different treatment modalities

MSCs to PRP	PRP to HA	HA to MSCs
(1) Both MSCs and PRP intra-articular injections resulted in pain relief and overall clinical improvement over similar time frames	(1) Both PRP and HA alleviated catabolism, but PRP showed better reduction in cartilage breaking enzymes and increased cartilage synthetic activity	(1) AD-MSC therapy demonstrated superior efficacy over HA injections
(2) Both MSCs and PRP showed significantly better clinical improvement when compared to HA	(2) In a randomized clinical trial, PRP demonstrated superiority over HA in long-term pain reduction and improvement in quality of life for OA patients	(2) AD-MSC-treated patients showed increased knee cartilage volume at 12 mo, indicating potential long-term structural benefits compared to HA
(3) Unlike PRP, AD-MSCs resulted in significant structural improvement, suggesting that they could serve as a more effective long-term treatment option for knee OA	(3) Comparisons between leukocyte-poor PRP and HA showed significant improvement with PRP in WOMAC and IKDC scores at 12 mo	(3) UC-MSC injections, administered in multiple doses, led to superior long-term clinical improvements in knee OA, in comparison to HA injections
		(4) Neither UC-MSC nor HA injections showed structural improvement on radiological outcomes, suggesting potential limitations of both therapies in addressing OA progression
		(5) HA injections offer temporary relief lasting up to several months, compared to UC-MSCs that can last up to 33 mo with invasive methods
		(6) Injections and MSC therapy exhibit favorable safety profiles, with few severe adverse events reported

PRP: Platelet-rich plasma; OA: Osteoarthritis; MSCs: Mesenchymal stem cells; HA: Hyaluronic acid; UC-MSC: Umbilical cord derived mesenchymal stem cells; WOMAC: Western Ontario and McMaster Universities Osteoarthritis index; IKDC: International Knee Documentation Committee.