scholarly journals Arthroscopic Cartilage Regeneration Facilitating Procedure: A Decompressing Arthroplasty for Knee Osteoarthritis

2020 ◽  
Author(s):  
Shaw-Ruey Lyu ◽  
Jung-pin Hung ◽  
Chia-Chen Hsu ◽  
Yu-Ruei Chen ◽  
Chih-Wen Lin
Keyword(s):  
Knee Osteoarthritis ◽  
Cartilage Regeneration ◽  
Outcome Study ◽  
Knee Oa ◽  
Radiographic Outcomes ◽  
Operative Care ◽  
Medial Plica ◽  
Magnetic Resonance Imaging Mri ◽  
Objective Outcomes ◽  
One Year

Abstract Background The effectiveness of arthroscopic treatment for knee osteoarthritis (OA) has been subject to debate. This study presents an innovative concept of arthroscopic management for knee OA and investigates its clinical outcome.Methods An arthroscopic cartilage regeneration facilitating procedure (ACRFP) to eliminate medial abrasion phenomenon and decompress the patello-femoral joints was performed on 693 knees of 411 patients with knee OA, mean age 60 years (34-90). The Knee Society score (KSS) and the knee injury and osteoarthritis outcome score (KOOS) were used for subjective outcome study. Roentgenographic changes for all cases and magnetic resonance imaging (MRI) variations for twenty randomly selected cases were evaluated for objective outcomes. Results There were 634 knees in 369 patients (93.7%) available with more than 3 years of follow-ups (mean 40 months, SD 9). The overall subjective satisfactory rate was 91.1%. The KSS and all subscales of the KOOS improved statistically. Reversal of the degeneration process of cartilage was observed in 80.1% of the whole series (radiographic outcome) and in 72.2% of the 18 randomly selected cases (one-year MRI outcome study). Gender and OA severity were related to subjective outcomes. Age, body mass index (BMI), pre-operative hyaluronic acid injection, OA severity, and the type and severity of the medial plica are important predictors of radiographic outcomes. An analysis of failed cases reaffirmed the need for early ACRFP and skillful post-operative care. Conclusion ACRFP is an effective treatment for knee OA. If performed in time, it can satisfy most patients and might modify their degeneration process.

scholarly journals Arthroscopic Cartilage Regeneration Facilitating Procedure: A Decompressing Arthroplasty for Knee Osteoarthritis

2021 ◽  
Author(s):  
Shaw-Ruey Lyu ◽  
Jung-Pin Hung ◽  
Chia-Chen Hsu ◽  
Yu-Ruei Chen ◽  
Chih-Wen Lin
Keyword(s):  
Knee Osteoarthritis ◽  
Cartilage Regeneration ◽  
Outcome Study ◽  
Knee Oa ◽  
Radiographic Outcomes ◽  
Operative Care ◽  
Medial Plica ◽  
Magnetic Resonance Imaging Mri ◽  
Objective Outcomes ◽  
One Year

Abstract Background The effectiveness of arthroscopic treatment for knee osteoarthritis (OA) has been subject to debate. This study presents an innovative concept of arthroscopic management for knee OA and investigates its clinical outcome.Methods An arthroscopic cartilage regeneration facilitating procedure (ACRFP) to eliminate medial abrasion phenomenon and decompress the patello-femoral joints was performed on 693 knees of 411 patients with knee OA, mean age 60 years (34-90). The Knee Society score (KSS) and the knee injury and osteoarthritis outcome score (KOOS) were used for subjective outcome study. Roentgenographic changes for all cases and magnetic resonance imaging (MRI) variations for twenty randomly selected cases were evaluated for objective outcomes. Results There were 634 knees in 369 patients (93.7%) available with more than 3 years of follow-ups (mean 40 months, SD 9). The overall subjective satisfactory rate was 91.1%. The KSS and all subscales of the KOOS improved statistically. Reversal of the degeneration process of cartilage was observed in 80.1% of the whole series (radiographic outcome) and in 72.2% of the 18 randomly selected cases (one-year MRI outcome study). Gender and OA severity were related to subjective outcomes. Age, body mass index (BMI), pre-operative hyaluronic acid injection, OA severity, and the type and severity of the medial plica are important predictors of radiographic outcomes. An analysis of failed cases reaffirmed the need for early ACRFP and skillful post-operative care. Conclusion ACRFP is an effective treatment for knee OA. If performed in time, it can satisfy most patients and might modify their degeneration process.

scholarly journals Factors Influencing Clinical and MRI Outcomes of Mesenchymal Stem Cell Implantation With Concomitant High Tibial Osteotomy for Varus Knee Osteoarthritis

2021 ◽  
Vol 9 (2) ◽  
pp. 232596712097998
Author(s):  
Yong Sang Kim ◽  
Dong Suk Suh ◽  
Dae Hyun Tak ◽  
Pill Ku Chung ◽  
Yoo Beom Kwon ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
High Tibial Osteotomy ◽  
Cartilage Regeneration ◽  
Tibial Osteotomy ◽  
Varus Knee ◽  
Patient Age ◽  
Knee Oa ◽  
Radiographic Outcomes ◽  
Factors Influencing ◽  
Patient Âgé

Background:Cartilage repair procedures using mesenchymal stem cells (MSCs) can provide superior cartilage regeneration in the medial compartment of the knee joint when high tibial osteotomy (HTO) is performed for varus knee osteoarthritis (OA). However, few studies have reported the factors influencing the outcomes of MSC implantation with concomitant HTO.Purpose:To investigate the outcomes of MSC implantation with concomitant HTO and to identify the prognostic factors that are associated with the outcomes.Study Design:Case series; Level of evidence, 4.Methods:A total of 71 patients (75 knees) were retrospectively evaluated after MSC implantation with concomitant HTO. Clinical and radiological outcomes were evaluated, and magnetic resonance imaging (MRI) was used to assess cartilage regeneration. Statistical analyses were performed to determine the effect of different factors on clinical, radiographic, and MRI outcomes.Results:Clinical and radiographic outcomes improved significantly from preoperatively to final follow-up ( P < .001 for all), and overall cartilage regeneration was encouraging. Significant correlations were found between clinical and MRI outcomes. However, radiographic outcomes were not significantly correlated with clinical or MRI outcomes. Patient age and number of MSCs showed significant correlations with clinical and MRI outcomes. On multivariate analyses, patient age and number of MSCs showed high prognostic significance with poor clinical outcomes.Conclusion:MSC implantation with concomitant HTO provided feasible cartilage regeneration and satisfactory clinical outcomes for patients with varus knee OA. Patient age and number of MSCs were important factors that influenced the clinical and MRI outcomes of MSC implantation with concomitant HTO for varus knee OA.

scholarly journals Intra-Articular Injection of Autologous Adipose-Derived Stromal Vascular Fractions for the Cartilage Repair of Grade 2 and 3 Knee Osteoarthritis: A Confirmatory Clinical Trial

2021 ◽  
Author(s):  
Yin Zhang ◽  
Qing Bi ◽  
Taihen Yu ◽  
Zheping Hong ◽  
Yu Tong ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Knee Osteoarthritis ◽  
Cartilage Repair ◽  
Clinical Symptoms ◽  
Rapid Development ◽  
Cartilage Regeneration ◽  
Substantial Improvement ◽  
Clinical Trial Registry ◽  
Knee Oa ◽  
Grade 3

Abstract BackgroundCartilage defect remains one of the most important reasons for the rapid development of knee osteoarthritis (OA). Numerous reports have confirmed the safety and clinical efficacy of autologous adipose-derived stromal vascular fractions (SVF), which has recently been used clinically to treat patients with knee OA. However, there is still no consensus as to whether SVF can promote cartilage regeneration. Herein, we purposed to evaluate the effectiveness of SVF in cartilage regeneration by developing cartilage model based on the 3D-FS-SPGR sequence.MethodsPatients with Kellgren-Lawrence grade 2-3 knee OA were recruited in our research. Then, we monitored patients and subsequently scored symptoms using WOMAC, VAS, and range of motion (ROM) before treatment and at 1, 3, 6, and 12 months post-treatment. The WORMS and MOCART were recorded by magnetic resonance imaging. The cartilage model of the patient was established using the 3D-FS-SPGR sequence, while the relevant parameters of the model were counted at baseline, 6, and 12 months.ResultsWe enrolled 47 patients (53 knees) with knee OA in this study, of which 29 knees were classified as grade 2, while 24 were assigned grade 3. No treatment-related adverse event was observed in our study. Notably, WOMAC, VAS, and ROM showed a significant improvement at 12 months. We further found that the thickness, volume, and surface of the cartilage defect decreased, while the volume of healthy cartilage increased in all regions, particularly in the medial femoral and tibia condyle. Moreover, the scores of WORMS and MOCART revealed a substantial improvement of cartilage repair at 12 months. ConclusionsTaken together, this study shows that intra-articular injection of SVF into the knee markedly improved the clinical symptoms of patients without the occurrence of adverse events, thereby repairing the damaged articular cartilage through cartilage regeneration.Trial registrationRetrospectively registered. Chinses Clinical Trial Registry with identifier ChiCTR2100042930. Registered 28 January 2021.

scholarly journals Mesenchymal stem cells - a promising strategy for treating knee osteoarthritis

2020 ◽  
Vol 9 (10) ◽  
pp. 719-728
Author(s):  
Jiaqian Wang ◽  
Liang Zhou ◽  
Yong Zhang ◽  
Lixin Huang ◽  
Qin Shi
Keyword(s):  
Stem Cells ◽  
Mesenchymal Stem Cells ◽  
Knee Osteoarthritis ◽  
Low Dose ◽  
Meta Analysis ◽  
Cartilage Regeneration ◽  
Cochrane Library ◽  
P Values ◽  
Knee Oa ◽  
Primary Evaluation

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.

scholarly journals Stem cell doses in knee osteoarthritis

2019 ◽  
Vol 25 (2) ◽  
pp. 101
Author(s):  
Samuel Eduardo Trujillo Henao ◽  
Julieta Henao Bonilla ◽  
Gustavo Adolfo Marín S. ◽  
Camila Vargas M. ◽  
Jainer Aranzazu ◽  
...  
Keyword(s):  
Stem Cells ◽  
Knee Osteoarthritis ◽  
Randomized Clinical Trials ◽  
Good Reason ◽  
Cartilage Regeneration ◽  
Functional Improvement ◽  
Knee Oa ◽  
Medical Evaluation ◽  
Before And After

Osteoarthritis (OA) is a degenerative disease where conventional treatment includes drugs, physiotherapy, or prostheses. Stem cells and growth factors are a promising option in controlling symptoms, functional improvement and cartilage regeneration; however, many treatment details have not been specified, such as type and number of stem cells that should be applied to obtain optimal results. In this study we sought to compare effectiveness, safety and costs of two doses (1X107vs 3X107) of adipose tissue derived stem cells (ADSC), applied intra-articularly. Ten patients, with knee OA grades II and III, were randomized to receive 10 (n=5) or 30 million (n=5) of autologous ADSCs. At baseline and 6 to 10 months after injection, they were evaluated according to clinical (medical evaluation, WOMAC scale, quality of life) and paraclinical criteria (arthroscopy, resonance, biopsy). In terms of effectiveness and safety there were no differences observed among the two dosage groups since all patients had improvement according to medical criteria and the WOMAC scale (P=0,001); in the arthroscopic control, 7 patients had "good/very good" response, 1 "neutral" and 2 forwent control; biopsies confirm joint regeneration, although there were no differences in the before and after magnetic resonances. In knee osteoarthritis, the application of 10 or 30 million ADSCs was equally effective and safe; however, the protocol with 10 million cells does not require in vitro expansion, requires less time, is simpler and has a lower cost. This study shows good reason to undertake randomized clinical trials to gain higher quality evidence.

scholarly journals Supartz (Sodium Hyaluronate) for the Treatment of Knee Osteoarthritis: A Review of Efficacy and Safety

2019 ◽  
Vol 12 ◽  
pp. 117954411983522 ◽  
Author(s):  
Amy Bronstone ◽  
Jacob T Neary ◽  
Todd H Lambert ◽  
Vinod Dasa
Keyword(s):  
Knee Osteoarthritis ◽  
Sodium Hyaluronate ◽  
The United States ◽  
Gait Pattern ◽  
Efficacy And Safety ◽  
Knee Oa ◽  
History Of ◽  
Pharmacologic Treatments ◽  
Objective Outcomes ◽  
Improved Function

As concerns about the safety of systemic oral pharmacologic treatments for knee osteoarthritis (OA) mount, clinicians have increased the use of intra-articular hyaluronic acid (IA-HA) in managing mild-to-moderate knee OA. Supartz (sodium hyaluronate; Seikagaku Corporation, Tokyo, Japan) is the first IA-HA product to be approved in the world and has the longest history of global use. In this review, we summarize evidence supporting Supartz efficacy and safety, including data from pivotal clinical trials that resulted in approval of Supartz in the United States and Japan, the safety of single and repeated courses of Supartz, and Supartz efficacy using objective outcomes and in special populations. There is strong evidence that single 5-week courses of Supartz provide clinically meaningful reductions in pain and improved function for up to 6 months without risk of serious side effects or complications. Repeated courses of Supartz are as safe as single courses and have an extremely low risk of infection. Findings from promising initial studies, which suggest that Supartz may improve muscle strength, gait pattern, and balance, should be confirmed in randomized controlled trials.

scholarly journals Single Injection of High Volume of Autologous Pure PRP Provides a Significant Improvement in Knee Osteoarthritis: A Prospective Routine Care Study

2019 ◽  
Vol 20 (6) ◽  
pp. 1327 ◽  
Author(s):  
Caroline Guillibert ◽  
Caroline Charpin ◽  
Marie Raffray ◽  
Annie Benmenni ◽  
Francois-Xavier Dehaut ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Large Volume ◽  
Single Injection ◽  
Platelet Rich Plasma ◽  
High Volume ◽  
Routine Care ◽  
Functional Improvement ◽  
Knee Oa ◽  
Symptomatic Knee ◽  
Magnetic Resonance Imaging Mri

Background: Evidence is growing regarding the ability of platelet-rich plasma (PRP) injections to enhance functional capacity and alleviate pain in knee osteoarthritis (OA). However, heterogeneity in common practice regarding PRP preparation and biological content makes the initiation of this activity in a hospital complex. The aim of this study was to document the efficacy of a single PRP injection to treat knee OA and validate a routine care procedure. Methods: Fifty-seven patients with symptomatic knee OA received a single injection of large volume of very pure PRP. They were assessed at baseline and after one, three and six months, by measuring Knee Injury and Osteoarthritis Score (KOOS), Observed Pain after a 50-foot walk test and Visual Analog Scale (VAS) assessments. Magnetic Resonance Imaging (MRI) analysis was performed at baseline and six months after the procedure. The objective was to recover 50% of responders three months after the procedure using OMERACT-OARSI criteria. Results: A single administration of high volume pure PRP provided significant clinical benefit for 84.2% of the responders, three months after the procedure. The KOOS total score significantly increased from 43.5 ± 14.3 to 66.4 ± 21.7 six months after the procedure (p < 0.001). Pain also significantly decreased from 37.5 ± 25.1 to 12.9 ± 20.9 (p < 0.001). No difference was observed on MRI parameters. Conclusion: A single injection of large volume of very pure PRP is associated with significant functional improvement and pain relief, allowing initiation of daily PRP injection within our hospital.

scholarly journals Injectable Amniotic Membrane/Umbilical Cord Particulate for Knee Osteoarthritis: A Prospective, Single-Center Pilot Study

Pain Medicine ◽  
2019 ◽  
Vol 20 (11) ◽  
pp. 2283-2291 ◽  
Author(s):  
Ramon Castellanos ◽  
Sean Tighe
Keyword(s):  
Pilot Study ◽  
Knee Osteoarthritis ◽  
Physical Function ◽  
Umbilical Cord ◽  
Amniotic Membrane ◽  
Single Center ◽  
Medication Usage ◽  
Knee Oa ◽  
Symptomatic Knee ◽  
Magnetic Resonance Imaging Mri

Abstract Objective To evaluate the short-term safety and effectiveness of amniotic membrane/umbilical cord particulate (AMUC) in managing pain in patients with various severities of knee osteoarthritis (OA). Design Single-center, prospective, investigator-initiated pilot study. Setting Private practice. Subjects A total of 20 knee OA patients aged ≥18 years were enrolled with pain >40 mm, as determined by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)–A. Methods Patients received an ultrasound-guided, intra-articular injection of 50 mg of AMUC particulate reconstituted in 2 mL of preservative-free saline. All patients were then monitored at six weeks, 12 weeks, and 24 weeks postinjection. Patients who did not show >30% reduction in pain received a second injection of AMUC at six weeks. WOMAC, Patient Global Assessment, medication usage, and magnetic resonance imaging (MRI) were assessed. Results Knee OA pain significantly decreased from 74.3 ± 17.2 at baseline to 45.0 ± 25.4 at six weeks (P < 0.01), 35.4 ± 26.6 at 12 weeks (P < 0.001), and 37.4 ± 26.7 at 24 weeks (P < 0.001). This pain reduction was associated with a significant improvement in physical function (WOMAC-C) at all time points (P < 0.05) and stiffness (WOMAC-B) at 12 weeks (P = 0.01). Eleven patients received a second injection, which was significantly correlated with body mass index >30 kg/m2 (P = 0.025). MRI evaluation of the overall population revealed an improvement in the severity of bone marrow lesions in seven patients. No adverse events were observed. Conclusions AMUC particulate injection relieved pain and improved physical function in patients with symptomatic knee OA.

scholarly journals Adipose-Derived Mesenchymal Stem Cells for the Treatment of Knee Osteoarthritis: A Systematic Review

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Milani L ◽  
◽  
Wang S ◽  
Keyword(s):  
Systematic Review ◽  
Stem Cells ◽  
Mesenchymal Stem Cells ◽  
Knee Osteoarthritis ◽  
Functional Outcomes ◽  
Cartilage Regeneration ◽  
Adipose Derived Stem Cells ◽  
Resonance Imaging ◽  
Magnetic Resonance Imaging Mri

Purpose: For several years, adipose tissue has gained increasing interest as an ideal source of mesenchymal stem cells for the regenerative treatment of numerous pathologies and degenerative processes, as like Knee Osteoarthritis (KOA). The aim of our study was to report postoperative clinical, functional and radiological outcomes in patients with KOA treated with intra-articular injection of autologous Adipose-Derived Stem Cells (ADSCs). Methods: We performed a systematic review searching for all the clinical studies dealing with the use of ADSCs for the treatment of KOA published in PubMed and Embase until April 2021. We included 8 prospective studies dealing with postoperative outcomes after ADSCs therapy. Results: All clinical and functional outcomes improved after intra-articular injections of ADSCs. Postoperative magnetic resonance imaging (MRI) scores showed an increased quality of repaired cartilage compared to the preoperative time. No serious advent events were observed. Conclusion: This study suggests that ADSCs therapy seems to be safe and effective. It can be considered an innovative procedure for improved cartilage regeneration and as adjuvant for the surgical treatment of diffuse degenerative chondral lesions with good clinical and radiological outcomes.

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