Comparative matched-pair cohort analysis of the short-term clinical outcomes of mesenchymal stem cells versus hyaluronic acid treatments through intra-articular injections for knee osteoarthritis

Abstract

Purpose Intra-articular injection of hyaluronic acid (HA) has shown promises in reducing pain and improving physical function in knee osteoarthritis (OA). Recently, cell-based therapies using mesenchymal stem cells (MSCs) have emerged as potential treatments. However, few studies have compared the treatment outcomes between MSCs and HA. This study aimed to compare the clinical and radiological outcomes of intra-articular injections of MSCs versus HA in patients with knee OA. Methods A cohort of 209 patients with knee OA were retrospectively screened for those who underwent intra-articular injections using MSCs or HA. Thirty MSC-treated patients (MSC group) were pair-matched with thirty HA-treated patients (HA group) based on gender and age. Clinical outcomes were evaluated using the visual analog scale (VAS), International Knee Documentation Committee (IKDC) rating system, and Lysholm scoring system. Radiological evaluation was assessed using the Kellgren-Lawrence (K-L) grading system. Results MSC treatment yielded consistent significant improvements in VAS, IKDC and Lysholm scores. In the HA group, VAS scores significantly decreased at 1 month, slightly increased at 3 months, and increased significantly from 3 months to 1 year after injection. The IKDC and Lysholm scores improved significantly until 3 months, but gradually worsened thereafter. Significantly greater improvements in VAS (P = 0.041), IKDC (P = 0.014), and Lysholm (P = 0.020) scores were observed in the MSC group compared to those in the HA group at 1-year post-treatment. The K-L grade worsened in a few patients, especially those in the HA group, albeit no significant difference. Conclusions MSC group showed better VAS, IKDC, and Lysholm scores at 1-year post-treatment, compared to the HA group, although earlier clinical improvements were superior in the HA group for the initial 3 months. Level of Evidence Therapeutic study, Level III.

Effect of mesenchymal stromal cells transplantation on the outcomes of patients with knee osteoarthritis: A systematic review and meta‐analysis

“…Furthermore, cord‐blood‐derived stem cells lead to the greatest reduction in pain sensation at postoperative 3 months and postoperative 6 months 18 . Autologous adipose tissue is better at relieving pain than allogeneic adipose tissue of ADSCs 17,24–26 . Stem cells derived from autologous bone marrow cells were no better at relieving pain than stem cells derived from allogeneic bone marrow, 28,31 and combination therapy (HA and/or PRP) in the analyses has no effect 19,27 …”

“…After preliminary screening, 95 were excluded due to irrelevance, and the remaining 92 were read in full text. Further, 76 were excluded based on patient, intervention, comparison, outcome study (PICOS) principles, inclusion or exclusion criteria, and data extraction criteria, finally resulting in 16 publications, [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] as detailed in Figure 1. high-quality.…”

“…18 Autologous adipose tissue is better at relieving pain than allogeneic adipose tissue of ADSCs. 17,[24][25][26] Stem cells derived from autologous bone marrow cells were no better at relieving pain than stem cells derived from allogeneic bone marrow, 28,31 and combination therapy (HA and/or PRP) in the analyses has no effect. 19,27…”

Effect of Warm Acupuncture Combined with Bone Marrow Mesenchymal Stem Cells Transplantation on Cartilage Tissue in Rabbit Knee Osteoarthritis

“…The cell suspension was collected, followed by centrifugation at 1000 r/min for 3 min, and the supernatant was suspended with NS. After adjusting the cell concentration to 1 × 10 6 /mL, the cell suspension was separated into a 1 mL syringe for reserve [ 23 , 24 ].…”

A comprehensive review of intraarticular knee injection therapy, geniculate injections, and peripheral nerve stimulation for knee pain in clinical practice

“…Nevertheless, a larger sample size with longer studies are needed for validation. 55 Similarly, Lamo-Espinosa et al conducted a randomized clinical study comparing the effects of HA treatment alone (control) or combined with increasing doses of bone marrow MSCs on 30 knee OA patients. Compared to the control group, bone marrow MSC + HA treatment group had a better VAS score without adverse effects in all follow ups up to 12 months.…”