Intra-Articular Cellular Therapy for Osteoarthritis and Focal Cartilage Defects of the Knee

Chahla, Jorge; Piuzzi, Nicolás S.; Mitchell, Justin J.; Dean, Chase S.; Pascual‐Garrido, Cecilia; LaPrade, Robert F.; Muschler, George F.

doi:10.2106/jbjs.15.01495

Cited by 108 publications

(86 citation statements)

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“…Others have postulated that the beneficial effects of BMAC are related to the mesenchymal stem cell (MSC) content. 7 The number of MSCs in BMAC, although relatively small in quantity, varies depending on the site of harvest and patient sex and age. 13 Lavasani et al postulated that the therapeutic effects of MSCs were mediated by secreted factors.…”

Section: Application Of Bmacmentioning

confidence: 99%

“…[1][2][3][4] After density gradient centrifugation to remove red blood cells, granulocytes, immature myeloid precursors, and platelets, progenitor cells account for a small population within the bone marrow (0.001% to 0.01%). [5][6][7] However, a high concentration of growth factors, including platelet-derived growth factor, transforming growth factor-b, and bone morphogenetic proteins 2 and 7, which are reported to have anabolic and antiinflammatory effects, [8][9][10] are present in BMAC. Of note, it has been reported that BMAC has a considerable concentration of interleukin-1 receptor antagonist (IL-1RA).…”

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confidence: 99%

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Bone Marrow Aspirate Concentrate Harvesting and Processing Technique

Chahla

Mannava

Cinque

et al. 2017

Arthroscopy Techniques

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138

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Bone marrow obtained by iliac crest aspiration is a common source for harvesting mesenchymal stem cells, other progenitor cells, and associated cytokine/growth factors. Recent studies have reported good to excellent outcomes with the use of bone marrow aspirate concentrate (BMAC) for pain relief in the treatment of focal chondral lesions and osteoarthritis of the knee. However, the harvesting and processing technique are crucial to achieve satisfactory results. Several studies have examined outcomes after BMAC injection, with encouraging results, but there is a lack of consensus in terms of the frequency of injection, the amount of BMAC that is injected, and the timing of BMAC injections. The purpose of this Technical Note was to describe a standardized bone marrow aspiration harvesting technique and processing method. Bone marrow obtained by iliac crest aspiration is a common source for harvesting mesenchymal stem cells, other progenitor cells, and associated cytokine/ growth factors. Because the use of bone marrow aspirate concentrate (BMAC) is currently approved by the United States Food and Drug Administration, it represents one of the few means for acquiring progenitor cells and growth factors for subsequent injection.

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Section: Application Of Bmacmentioning

confidence: 99%

mentioning

confidence: 99%

Bone Marrow Aspirate Concentrate Harvesting and Processing Technique

Chahla

Mannava

Cinque

et al. 2017

Arthroscopy Techniques

Self Cite

138

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“…These histological observations suggest that inflammation subsides under this pathology [39]. PRP releases growth factors and cytokines that reduce inflammation, and stimulate cartilage regeneration [41]. Ozone could act on inflammation, modulate it and act on many other targets such as growth factors, stem cells, inflammatory cytokines, all of them could stimulate chondrocyte growth and cartilage repair [24].…”

Section: Discussionmentioning

confidence: 99%

Efficiency of Platelet-rich Plasma (PRP) Compared to Ozone Infiltrations on Patellofemoral Pain Syndrome and Chondromalacia: A Non- Randomized Parallel Controlled Trial

Fernández-Cuadros¹,

Albaladejo-Florín²,

Algarra-López³

et al. 2017

Divers Equal Health Care

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Objective: 1) to determine the efficiency of PRP compared to Ozone Infiltrations on pain, function and quality of life (QoL) in patients with Patellofemoral Pain Syndrome (PFPS) and Chondromalacia. Material and methods:Prospective non-randomized controlled-trial, comparing two treatment protocols in parallel design, on 48 patients (24 in each group), with PFPS and Chondromalacia , who were treated at Santa Cristina's University Hospital, from January 2014 to May 2017. The PRP-protocol consisted of 3 sessions (1 session/week) of platelet-rich plasma (PRP), by an intra-articular infiltration of 3 ml. To obtain PRP, a kit device from EXACTECH (Accelerate Concentration System Device and Drucker Centrifuge was used.The Ozone-protocol consisted of 4 sessions (1 per week) of a medical mixture of Oxygen-Ozone (95%-5%) 20 ml, at a 20 ug/ml concentration, infiltrated intra-articularly. Pain, function, stiffness and Quality of Life were measured by Western Ontario and Mc Master Universities Index for Osteoarthritis (WOMAC) and Visual Analogical Scale (VAS) at baseline/end of treatment.Results: At baseline, age, sex, ratio male to female, clinical chondromalacia grades and symptom severity such as pain, stiffness and function were similar between groups of treatment. In both groups, the most common grade of chondromalacia was 2º grade (41.8% in PRP, 50% in Ozone), followed by 3º (37.6% in PRP, 33.4% in Ozone) and 4º (16.6% in both PRP and Ozone). When treatment protocols are analyzed separately, both PRP and Ozone were capable to produce pain relief (measured by VAS and WOMAC pain subscale), and improvement in function and rigidity (measured by WOMAC subscales), with a significant statistical level (p<0.05). In the case of pain, Ozone is even more effective than PRP (1.46 points on VAS scale and 2.95 points on WOMAC pain subscale) (p<0.05).Conclusion: PRP and ozone produce pain relief, function recovery and quality of life improvement in PFPS and chondromalacia, measured by WOMAC and VAS scores. In the case of pain severity, ozone produces even greater pain relief. PRP and Ozone are safe and effective modalities for the management of PFPS and chondromalacia.

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“…Additionally, the body of literature is highly heterogeneous (with regard to indications, processing method, number, and form of applications), the improvements reported are usually modest and randomized, and unblinded methodologies do not control for patient‐ or clinician‐related bias. As a result, no strong conclusions can be drawn, suggesting that current methods of cell therapy provide generalizable benefits to patients …”

Section: Current Challenges and Future Directionsmentioning

confidence: 99%

“…As a result, no strong conclusions can be drawn, suggesting that current methods of cell therapy provide generalizable benefits to patients. 212 Tissue-engineered scaffolds, synthetics, nanotechnologies, bioprinting, and rapid-prototyping are alternative favorable approaches. However, it is equally difficult to remodel cartilage and bone tissues with implantable scaffolds, synthetics, and nanomolecules, because physical ailments and biomechanical derangements caused by injury, trauma, or wear and tear can impair their function.…”

Section: Current Challenges and Future Directionsmentioning

confidence: 99%

Current perspectives on biological approaches for osteoarthritis

Whitney

Liebowitz

Bolia

et al. 2017

Annals of the New York Academy of Sciences

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Musculoskeletal injuries that disrupt the structure and function of diarthrodial joints can cause permanent biomechanical alterations and lead to a more severe, chronic condition. Despite advancements that have been made to restore tissue function and delay the need for joint replacement, there are currently no disease-modifying therapies for osteoarthritis (OA). To reduce the risk of OA, innovative preventive medicine approaches have been developed over the last decade to treat the underlying pathology. Several biological approaches are promising treatment modalities for various stages of OA owing to their minimally invasive nature and actively dynamic physiological mechanisms that attenuate tissue degradation and inflammatory responses. Individualized growth factor and cytokine therapies, tissue-engineered biomaterials, and cell-based therapies have revolutionary potential for orthopedic applications; however, the paucity of standardization and categorization of biological components and their counterparts has made it difficult to determine their clinical and biological efficacy. Cell-based therapies and tissue-engineered biologics have become lucrative in sports medicine and orthopedics; nonetheless, there is a continued effort to produce a biological treatment modality tailored to target intra-articular structures that recapitulates tissue function. Advanced development of these biological treatment modalities will potentially optimize tissue healing, regeneration, and joint preservation strategies. Therefore, the purpose of this paper is to review current concepts on several biological treatment approaches for OA.

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Intra-Articular Cellular Therapy for Osteoarthritis and Focal Cartilage Defects of the Knee

Abstract: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cited by 108 publications

References 50 publications

Bone Marrow Aspirate Concentrate Harvesting and Processing Technique

Bone Marrow Aspirate Concentrate Harvesting and Processing Technique

Efficiency of Platelet-rich Plasma (PRP) Compared to Ozone Infiltrations on Patellofemoral Pain Syndrome and Chondromalacia: A Non- Randomized Parallel Controlled Trial

Current perspectives on biological approaches for osteoarthritis

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