Autologous protein solution as selective treatment for advanced patellofemoral osteoarthritis in the middle-aged female patient: 54% response rate at 1 year follow-up

Abstract

PurposeThe study wanted to investigate the benefit, durability and safety of autologous protein solution (APS) injection(s) in a middle‐aged female‐only cohort suffering predominantly from patellofemoral osteoarthritis. MethodsFifty females (aged 50.4 ± 6.5) with mainly moderate–severe (86%) patellofemoral cartilage wear (PFCW) were treated with a unilateral intra‐articular APS injection. The KOOS, NRS, Kujala, UCLA and EQ‐5D were assessed at baseline and 1, 3, 6, and 12 months post‐injection. Therapeutic response rate (TRR) was based on KOOS pain improvement > 10 points. Absolute improvement for, respectively, therapy responders and non‐responders was determined. Second APS injection was administered if improvement was deemed insufficient by the patient after 3 months. ResultsThe TRR remained stable averaging to 53.7% at final follow‐up with subjects improving overall from 40.3 ± 18.7 to 57.3 ± 24.8 points on KOOS pain (p = 0.0002) and from 48.4 ± 13.0 to 56.3 ± 18.1 points on Kujala (p = 0.0203) at 12 months. Significant improvement was observed for the other KOOS subscales and NRS at each follow‐up. In absolute values, APS responders improved with 30.5 ± 11.4 points on KOOS pain at 12 months. In contrast, non‐responders deteriorated with 5.9 ± 8.9 points relative to baseline. A second APS injection was administered in 28 subjects. Patients with definite synovitis improved more on KOOS symptoms (p = 0.017) and KOOS ADL (p = 0.037) at 12 months compared to non‐synovitis subjects. Mild‐moderate arthralgia (46%) and effusion (29%) were commonly observed during the first month post‐injection. ConclusionThis study evidenced a 54% response rate at 12 months to a single or second APS injection in a middle‐aged female population with advanced patellofemoral cartilage wear. Moderate temporary flares can be expected without affecting clinical outcomes. Second APS injection has low efficacy in initially poor responding patients after 3 months. Major synovitis on baseline MRI appeared to be a beneficial prognosticator for pain relief and functional improvement after APS. Level of evidenceIV.

Intraarticular injection of microfragmented adipose tissue plus arthroscopy in isolated primary patellofemoral osteoarthritis is clinically effective and not affected by age, BMI, or stage of osteoarthritis

“…[ 32 ] and Van Genechten et al. [ 36 ] showed how PFOA symptoms were recalcitrant to those treatments after 1 year of follow-up, while the present study reported good improvement at a mean follow-up of almost 2 years. On the other hand, Guimaraes et al.…”

“…Existing literature lacks evidence on the results in patients with isolated primary PFOA treated with autologous microfragmented adipose tissue injection, focusing on results obtained in patients with generic knee OA [ 17 , 28 ]. To our knowledge, only three studies have been previously published on alternative joint-preservation treatments of isolated primary PFOA: the first of these reported the results of concomitant intraarticular injection of MSCs and PRP [ 32 ], the second evaluated the efficacy and safety of autologous protein solution injection [ 36 ], the third evaluated treatment with autologous bone marrow mononuclear cells injection associated with arthroscopic debridement [ 14 ]. However, Pintat et al.…”

Autologous Protein Solution (APS) and Osteoarthritis of the Knee: A Scoping Review of Current Clinical Evidence

“…Genechten et al [11] Administration of IA APS led to significant improvement in NPRS, KOOS, and Kujala scores at 12 months' follow-up. Additionally, MRI analysis showed significant improvement in KOOS symptoms and ADL subscales, and Kujala score in patients with major synovitis compared to patients with non-synovitis at 12 months' follow-up.…”

“…Additionally, a retrospective study by Kuwasawa et al [ 12 ] conducted in a real-world clinical setting demonstrated that IA injection of APS is safe and efficacious in mild-to-moderate knee OA patients. This study [ 12 ] helped integrate the evidence from real-world populations with differing characteristics with prospective clinical studies [ 7 - 11 ], where the conditions are controlled, thereby improving the wholeness of evidence-based medicine evaluations [ 16 ]. One ongoing clinical trial is registered on the clinical trial protocol repositories (Table 2 ).…”

“…The results from this study demonstrated that the administration of APS is safe and efficacious in patients with mild to moderate knee OA. Genechten et al [11] investigated the advantages, durability, and safety of APS injection in a middle-aged female-only cohort suffering primarily from unilateral patellofemoral OA. The patients were assessed at baseline and one, three, and six and 12 months' follow-up and PROMs measured included numeric pain rating scale (NPRS), KOOS, Kujala anterior knee pain symptom questionnaire, University of California at Los Angeles (UCLA) activity score, and European Quality of Life 5 Dimensions (EQ-5D) VAS.…”