Efficacy of arthroscopic debridement combined with platelet-rich plasma injection for knee osteoarthritis: An updated systematic review and meta-analysis of randomized controlled trials

Objective This study aimed to provide an updated assessment of the clinical efficacy and safety of arthroscopic debridement combined with platelet-rich plasma injection for the treatment of knee osteoarthritis. Methods On 16 August 2025, we systematically searched multiple databases, including the Cochrane Library, Embase, Ovid Medline, PubMed, Web of Science, China Biology Medicine Disc, China National Knowledge Infrastructure, Wanfang, and VIP Chinese Science and Technology Journal Database (VIPC), for randomized controlled trials evaluating the efficacy of arthroscopic debridement combined with platelet-rich plasma injection in the management of knee osteoarthritis. Outcome measures included the following: (a) clinical response rate; (b) visual analog scale score; (c) Lysholm score; (d) Western Ontario and McMaster Universities Osteoarthritis Index score; and (e) adverse reactions. Data were recorded and analyzed using RevMan 5.4 software. The systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and the research protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO) platform (registration number: CRD420251127571). Results A total of 17 studies involving 1587 patients were included. Meta-analysis results showed that compared with the control group, the treatment group demonstrated a statistically significant difference in the overall clinical response rate: odds ratio = 5.38; 95% confidence interval: 3.45, 8.38; p  < 0.00001. Subgroup analyses based on follow-up duration (3, 6, and 12 months) demonstrated a p  value of 1.00 and I² value of 0%. Meta-analysis results for each subgroup were as follows: odds ratio = 5.66; 95% confidence interval: 2.14, 14.94; p  = 0.0005 for 3 months; odds ratio = 5.68; 95% confidence interval: 2.87, 11.27; p  < 0.00001 for 6 months; and odds ratio = 5.40; 95% confidence interval: 2.44, 11.96; p  < 0.0001 for 12 months. The treatment group also exhibited a statistically significant reduction in visual analog scale scores: mean difference = −0.62; 95% confidence interval: −1.03, −0.20; p  = 0.004. Lysholm scores increased significantly in the treatment group: mean difference = 5.07; 95% confidence interval: 2.99, 7.14; p  < 0.00001. The Western Ontario and McMaster Universities Osteoarthritis Index score indicated statistically significant difference: mean difference = −8.65; 95% confidence interval: −11.13, −6.18; p  < 0.00001. Adverse reaction rate demonstrated no statistically significant difference: odds ratio = 0.73; 95% confidence interval: 0.28, 1.89; P  = 0.52. Conclusion The overall clinical response rate of arthroscopic debridement combined with platelet-rich plasma injection for knee osteoarthritis was significantly higher than that of the control group. The visual analog scale scores were lower, indicating effective pain relief in patients with knee osteoarthritis. The Lysholm scores were higher, demonstrating a significant improvement in knee function compared to the control group. The Western Ontario and McMaster Universities Osteoarthritis Index scores were significantly lower than that of the control group, reflecting substantial efficacy of arthroscopic debridement combined with platelet-rich plasma injection in treating knee osteoarthritis by improving pain, stiffness, and functional impairment. The incidence of adverse reactions in the arthroscopic debridement combined with platelet-rich plasma injection group did not differ significantly from that in the control group, indicating that platelet-rich plasma injection does not increase the risk of adverse events.