Arthroscopic Subchondral Drilling Followed by Injection of Peripheral Blood Stem Cells and Hyaluronic Acid Showed Improved Outcome Compared to Hyaluronic Acid and Physiotherapy for Massive Knee Chondral Defects: A Randomized Controlled Trial

Saw, Khay-Yong; Anz, Adam W.; Ng, Reza Ching-Soong; Jee, Caroline Siew-Yoke; Low, Soo Fin; Dorvault, Christopher; Johnson, Kevin B.

doi:10.1016/j.arthro.2021.01.067

Cited by 15 publications

(10 citation statements)

References 37 publications

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“…Peripheral blood stem cells (PBSCs) have also shown the safety and potential for controlling KOA progress and ameliorating KOA-related pain and syndromes. 29 – 34 Administrating multiple doses of PBSCs promotes tissue repair on cartilage defects and bone marrow lesions 30 , 31 , 34 . The concentrated PBSCs are generally isolated from granulocyte colony-stimulating factor (G-CSF) -stimulated patients by leukapheresis 29 , 32 .…”

Section: Discussionmentioning

confidence: 99%

Enriched Peripheral Blood-Derived Mononuclear Cells for Treating Knee Osteoarthritis

et al. 2023

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Osteoarthritis (OA) is a common chronic skeletal disease in the elderly. There is no effective therapy to reverse disease severity and knee OA (KOA) progression, particularly at the late stage. This study aims to examine the effect of peripheral blood-derived mononuclear cells (PBMNCs) on pain and motor function rescue in patients with Kellgren–Lawrence (KL) grade II to IV KOA. Participants received one intra-articular (IA) injection of autologous PBMNCs. The mononuclear cells were isolated from peripheral blood, enriched by a specialized medium (MoFi medium), and separated by Ficoll-Paque solution. The isolated and enriched PBMNCs could differentiate into M1 and M2 macrophages in vitro. The in vivo anti-inflammatory effect of the PBMNCs was similar to that of bone marrow mesenchymal stem cells, evaluated by complete Freund’s adjuvant-induced arthritis in rodents. A single-arm and open-label pilot study showed that patients’ knee pain and motor dysfunction were significantly attenuated after the cell transplantation, assessed by visual analogue scale (VAS) and Knee injury and Osteoarthritis Outcome Score (KOOS) at 6 and 12 months post-treatment. Notably, the therapeutic effect of the PBMNCs treatment can be stably maintained for 24 months, as revealed by the KOOS scores. These preclinical and pilot clinical data suggest that IA injection of MoFi-PBMNCs might serve as a novel medical technology to control the pain and the progress of KOA.

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Section: Discussionmentioning

confidence: 99%

Enriched Peripheral Blood-Derived Mononuclear Cells for Treating Knee Osteoarthritis

et al. 2023

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“…The arthroscopic subchondral drilling procedure and chondrogenesis method for the knee joint has been described previously. [15][16][17]20 The details of PBSC harvesting procedure and cell preparation have been outlined in our previous publications. 15,16 In brief, filgrastim (Neupogen, Amgen, Thousand Oaks, CA, USA) were administered to mobilize the PBSC into blood stream and PBSC were harvested via apheresis using a Spectra Optia Apheresis Machine (CaridianBCT, Denver, CO, USA).…”

Section: Case Reportsmentioning

confidence: 99%

“…The collected PBSC were then cryopreserved in 4 mL vials and stored in liquid nitrogen at -196 C. PBSC administration and details of the physiotherapy regime have also been published. 17 In short, for the five cases presented here, each patient received a total of 17 injections. Intra-articular injections were given at week 1, 2, 3, 4, and 5 after surgery.…”

Section: Case Reportsmentioning

confidence: 99%

“…Autologous peripheral blood stem cells (PBSC) have been used as a cellular therapy to augment knee articular cartilage repair with reported clinical outcomes. Several case series and randomized controlled trials (RCT) were published [15][16][17] using PBSC addressing massive chondral defects in the knee joint with statistically significant results, addressing both the safety and efficacy aspects of PBSC therapy on chondrogenesis. 17 PBSC have also been shown to have the ability to regenerate bone with encouraging clinical results.…”

Section: Introductionmentioning

confidence: 99%

“…Several case series and randomized controlled trials (RCT) were published [15][16][17] using PBSC addressing massive chondral defects in the knee joint with statistically significant results, addressing both the safety and efficacy aspects of PBSC therapy on chondrogenesis. 17 PBSC have also been shown to have the ability to regenerate bone with encouraging clinical results. 18 In addition, an in vitro study has found PBSC to be pluripotent.…”

Section: Introductionmentioning

confidence: 99%

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Osteochondral Regeneration in the Knee Joint with Autologous Peripheral Blood Stem Cells plus Hyaluronic Acid after Arthroscopic Subchondral Drilling: Report of Five Cases

Saw,

Anz,

Jee

et al. 2023

Orthopaedic Surgery

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BackgroundTreatment of osteochondral defects (OCDs) of the knee joint remains challenging. The purpose of this study was to evaluate the clinical and radiological results of osteochondral regeneration following intra‐articular injections of autologous peripheral blood stem cells (PBSC) plus hyaluronic acid (HA) after arthroscopic subchondral drilling into OCDs of the knee joint.Case PresentationFive patients with OCDs of the knee joint are presented. The etiology includes osteochondritis dissecans, traumatic knee injuries, previously failed cartilage repair procedures involving microfractures and OATS (osteochondral allograft transfer systems). PBSC were harvested 1 week after surgery. Patients received intra‐articular injections at week 1, 2, 3, 4, and 5 after surgery. Then at 6 months after surgery, intra‐articular injections were administered at a weekly interval for 3 consecutive weeks. These 3 weekly injections were repeated at 12, 18 and 24 months after surgery. Each patient received a total of 17 injections. Subjective International Knee Documentation Committee (IKDC) scores and MRI scans were obtained preoperatively and postoperatively at serial visits. At follow‐ups of >5 years, the mean preoperative and postoperative IKDC scores were 47.2 and 80.7 respectively (p = 0.005). IKDC scores for all patients exceeded the minimal clinically important difference values of 8.3, indicating clinical significance. Serial MRI scans charted the repair and regeneration of the OCDs with evidence of bone growth filling‐in the base of the defects, followed by reformation of the subchondral bone plate and regeneration of the overlying articular cartilage.ConclusionThese case studies showed that this treatment is able to repair and regenerate both the osseous and articular cartilage components of knee OCDs.

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Treatment of knee cartilage lesions in 2024: From hyaluronic acid to regenerative medicine

Brittberg

2024

J. exp. orthop.

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Intact articular cartilage plays a vital role in joint homeostasis. Local cartilage repairs, where defects in the cartilage matrix are filled in and sealed to congruity, are therefore important treatments to restore a joint equilibrium. The base for all cartilage repairs is the cells; either chondrocytes or chondrogeneic cells from bone, synovia and fat tissue. The surgical options include bone marrow stimulation techniques alone or augmented with scaffolds, chondrogeneic cell implantations and osteochondral auto‐ or allografts. The current trend is to choose one‐stage procedures being easier to use from a regulatory point of view. This narrative review provides an overview of the current nonoperative and surgical options available for the repair of various cartilage lesions.Level of EvidenceLevel IV.

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Arthroscopic Subchondral Drilling Followed by Injection of Peripheral Blood Stem Cells and Hyaluronic Acid Showed Improved Outcome Compared to Hyaluronic Acid and Physiotherapy for Massive Knee Chondral Defects: A Randomized Controlled Trial

Cited by 15 publications

References 37 publications

Enriched Peripheral Blood-Derived Mononuclear Cells for Treating Knee Osteoarthritis

Enriched Peripheral Blood-Derived Mononuclear Cells for Treating Knee Osteoarthritis

Osteochondral Regeneration in the Knee Joint with Autologous Peripheral Blood Stem Cells plus Hyaluronic Acid after Arthroscopic Subchondral Drilling: Report of Five Cases

Treatment of knee cartilage lesions in 2024: From hyaluronic acid to regenerative medicine

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