Improved outcomes after mesenchymal stem cells injections for knee osteoarthritis: results at 12-months follow-up: a systematic review of the literature

Migliorini, Filippo; Rath, Björn; Colarossi, Giorgia; Driessen, Arne; Tingart, Markus; Niewiera, Marc; Eschweiler, Jörg

doi:10.1007/s00402-019-03267-8

Cited by 68 publications

(65 citation statements)

References 72 publications

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“…Multiple studies have demonstrated that treatment with adipose tissue and its derivatives results in improvement in osteoarthritis symptoms in both the knee [ 19 , 20 , 21 , 22 ] and in the hip [ 23 ]. Other studies have shown similar results with bone marrow aspirate [ 24 , 25 , 26 , 27 , 28 , 29 ], and with a combination of bone marrow aspirate and adipose tissue [ 30 , 31 ]. Platelet rich plasma (PRP) has been shown to also improve arthritis symptoms [ 32 , 33 ].…”

Section: Introductionsupporting

confidence: 54%

Autologous Biologic Treatment with Fat, Bone Marrow Aspirate and Platelet Rich Plasma Is an Effective Alternative to Total Knee Arthroplasty for Patients with Moderate Knee Arthrosis

Prodromos

Finkle

2020

Medicines

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Background: Osteoarthrosis (OA) of the knee afflicts millions worldwide. Total Knee Arthroplasty (TKA) is common, but associated with substantial cost and morbidity. Prior studies of intra-articular injection of fat, bone marrow aspirate (BMA), and platelet rich plasma (PRP) have shown clinical benefit. We hypothesized that injection of autologous adipose tissue, BMA, and PRP would provide significant benefit for patients with moderate knee OA resulting in avoidance of total knee arthroplasty (TKA) in most, with discontinuance of NSAIDs and other drugs. Methods: 42 TKA candidate patients (47 knees) with moderate (Kellgren-Lawrence 2 and 3) knee OA who had failed conservative treatment had autologous adipose tissue, BMA, and PRP injection as an alternative to TKA in office using only local anesthetic. Patients had discontinuance of all nonsteroidal anti-inflammatory medicines (NSAIDs) and other analgesics, except acetaminophen, prior to treatment. Patients were evaluated with Knee injury and Osteoarthritis Outcome Score Physical Shortform (KOOS-PS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Single Assessment Numeric Evaluation (SANE) prior to treatment, and at 6 months, 1, and 2 years after treatment. Results: Follow up exceeded 80% at all time points. There were no significant adverse events. TKA was avoided in 97% at one and 86% at two years after treatment. Mean SANE, KOOS-PS, and WOMAC scores significantly improved at 6 months, 1, and 2 years post-treatment. WOMAC and SANE scores were higher at two versus one year post-treatment. Conclusions: Combined fat, BMA, and PRP injection is a safe and effective treatment for moderate knee OA, with reliable avoidance of TKA and possible continued improvement at two year follow-up.

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Section: Introductionsupporting

confidence: 54%

Autologous Biologic Treatment with Fat, Bone Marrow Aspirate and Platelet Rich Plasma Is an Effective Alternative to Total Knee Arthroplasty for Patients with Moderate Knee Arthrosis

Prodromos

Finkle

2020

Medicines

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“…In recent years, in addition to bone marrow-derived stem cells, adipose, umbilical cord, and synovium-derived cells have attracted an increasing amount of attention. 40 In our study, the adipose and umbilical cord stem cell groups had lower p-values, which were statistically significant and showed advantages in treating knee OA. Migliorini et al 41 reviewed 18 studies of fat- and bone marrow-derived MSCs used in the treatment of arthritis and found that cells from both sources improved pain and functional scores.…”

Section: Discussionmentioning

confidence: 46%

Mesenchymal stem cells - a promising strategy for treating knee osteoarthritis

Wang

Zhou

Zhang

et al. 2020

Bone & Joint Research

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Aims The purpose of our study was to determine whether mesenchymal stem cells (MSCs) are an effective and safe therapeutic agent for the treatment of knee osteoarthritis (OA), owing to their cartilage regeneration potential. Methods We searched PubMed, Embase, and the Cochrane Library, with keywords including “knee osteoarthritis” and “mesenchymal stem cells”, up to June 2019. We selected randomized controlled trials (RCTs) that explored the use of MSCs to treat knee OA. The visual analogue scale (VAS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC), adverse events, and the whole-organ MRI score (WORMS) were used as the primary evaluation tools in the studies. Our meta-analysis included a subgroup analysis of cell dose and cell source. Results Seven trials evaluating 256 patients were included in the meta-analysis. MSC treatment significantly improved the VAS (mean difference (MD), –13.24; 95% confidence intervals (CIs) –23.28 to –3.20, p = 0.010) and WOMAC (MD, –7.22; 95% CI –12.97 to –1.47, p = 0.010). The low-dose group with less than 30 million cells showed lower p-values for both the VAS and WOMAC. Adipose and umbilical cord–derived stem cells also had lower p-values for pain scores than those derived from bone marrow. Conclusion Overall, MSC-based cell therapy is a relatively safe treatment that holds great potential for OA, evidenced by a positive effect on pain and knee function. Using low-dose (25 million) and adipose-derived stem cells is likely to achieve better results, but further research is needed. Cite this article: Bone Joint Res 2020;9(10):719–728.

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“…After 12 months, WOMAC Function Scores, Lequesne Index Scores, Knee Injury and Osteoarthritis Outcome Score (KOOS), and the quality of life (QOL) of patients were significantly improved. 78 Compared with other treatments of cartilage regeneration, BMSCs are autologous which avoids the risk of autoimmune responses. Meanwhile, the number and purity of BMSCs are high, and it is easier to differentiate into articular tissue.…”

Section: Mesenchymal Stem Cell (Msc)mentioning

confidence: 99%

<p>Development and Prospect of Intra-Articular Injection in the Treatment of Osteoarthritis: A Review</p>

Yin

Chen

Yu³

et al. 2020

JPR

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Osteoarthritis (OA) is a common degenerative disease that affects the vast majority of the elderly and may eventually embark on the road of the total knee arthroplasty (TKA), although controversy still exists in the medical community about the best therapies for osteoarthritis. Compared with physical therapy, oral analgesics and other non-operative treatments, intra-articular injection is more safe and effective. Moreover, intra-articular injection is much less invasive and has fewer adverse reactions than surgical treatment. This article reviews mechanism, benefits and adverse reactions of corticosteroids (CS), hyaluronic acid (HA), platelet-rich plasma (PRP), mesenchymal stem cell (MSCs), stromal vascular fraction (SVF) and other new therapies (for example: gene therapy). The application prospect of intra-articular injection was analyzed according to the recent progress in drug research.

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Improved outcomes after mesenchymal stem cells injections for knee osteoarthritis: results at 12-months follow-up: a systematic review of the literature

Cited by 68 publications

References 72 publications

Autologous Biologic Treatment with Fat, Bone Marrow Aspirate and Platelet Rich Plasma Is an Effective Alternative to Total Knee Arthroplasty for Patients with Moderate Knee Arthrosis

Autologous Biologic Treatment with Fat, Bone Marrow Aspirate and Platelet Rich Plasma Is an Effective Alternative to Total Knee Arthroplasty for Patients with Moderate Knee Arthrosis

Mesenchymal stem cells - a promising strategy for treating knee osteoarthritis

<p>Development and Prospect of Intra-Articular Injection in the Treatment of Osteoarthritis: A Review</p>

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