Effect of Intraarticular Injection of Platelet-Rich Plasma on Knee Osteoarthritis: A Multicenter Retrospective Clinical Study

This study aimed to evaluate the effect of intraarticular injection with platelet-rich plasma on knee osteoarthritis. A total of 250 patients with stages I–III osteoarthritis from December 2018 to June 2020 were included in this study. All the patients had received autologous PRP injection (3 ml) into the affected knee joint every week for totally 3 injections. The VAS score and WOMAC index were used to evaluate knee function before and at 3 days, 1 month, and 3 months after injection. A total of 250 patients were enrolled in this study, including 130 patients in the PRP group and 120 patients in the control group. The content of platelets in PRP of patients in the PRP group was 958.0 ± 283.1 × 109/L. The VAS score and WOMAC index of patients in the PRP group before treatment were not significantly different from those in the control group. At 3 days, 1 month, and 3 months after PRP treatment, the VAS score and WOMAC index of the PRP group were significantly lower than those of the control group. PRP is effective in treatment of knee osteoarthritis. The pain symptoms can be alleviated at 3 days after injection.

Canine Mesenchymal Cell Lyosecretome Production and Safety Evaluation after Allogenic Intraarticular Injection in Osteoarthritic Dogs

In recent years, mesenchymal stromal cells (MSCs) have shown promise as a therapy in treating musculoskeletal diseases, and it is currently believed that their therapeutic effect is mainly related to the release of proteins and extracellular vesicles (EVs), known as secretome. In this work, three batches of canine MSC-secretome were prepared by standardized processes according to the current standard ISO9001 and formulated as a freeze-dried powder named Lyosecretome. The final products were characterized in protein and lipid content, EV size distribution and tested to ensure the microbiological safety required for intraarticular injection. Lyosecretome induced the proliferation of adipose tissue-derived canine MSCs, tenocytes, and chondrocytes in a dose-dependent manner and showed anti-elastase activity, reaching 85% of inhibitory activity at a 20 mg/mL concentration. Finally, to evaluate the safety of the preparation, three patients affected by bilateral knee or elbow osteoarthritis were treated with two intra-articular injections (t = 0 and t = 40 days) of the allogeneic Lyosecretome (20 mg corresponding 2 × 106 cell equivalents) resuspended in hyaluronic acid in one joint and placebo (mannitol resuspended in hyaluronic acid) in the other joint. To establish the safety of the treatment, the follow-up included a questionnaire addressed to the owner and orthopaedic examinations to assess lameness grade, pain score, functional disability score and range of motion up to day 80 post-treatment. Overall, the collected data suggest that intra-articular injection of allogeneic Lyosecretome is safe and does not induce a clinically significant local or systemic adverse response.

Optimal Release Timing of Temporary Drain Clamping to Reduce Postoperative Bleeding After Total Knee Arthroplasty With an Intraarticular Injection of Tranexamic Acid

Background: Intraarticular injection of tranexamic acid (IA-TXA) plus drain-clamping is a preferred method of reducing bleeding after total knee arthroplasty (TKA). However, no consensus had been reached regarding the timing of clamping. The purpose of this study was to determine the optimum duration of drain-clamping after TKA with IA-TXA.Methods: We retrospectively reviewed 151 patients that underwent unilateral TKA with IA-TXA plus drain-clamping for 30 minutes (Group A, 60 patients), 2 hours (Group B, 42 patients), or 3 hours (Group C, 49 patients). Total drained volumes, hematocrit (Hct) reductions, estimated blood losses (EBLs), transfusion rates, and wound complications were reviewed.Results: Mean total drained volume, Hct reduction, EBL, and transfusion rate were significantly less in group C than in groups A or B (p < 0.01). No significant intergroup difference was found for wound-related complications. No surgical site infection or deep vein thrombosis was observed.Conclusion: IA-TXA plus drain-clamping for 3 hours is optimal for reducing blood loss with minimal complications after TKA.

Short Term Effectiveness of Intraarticular Injection of Methylprednisolone Acetate in Subacromial Impingement Syndrome in A Tertiary Care Hospital

Objective: To determine the effectiveness of intraarticular injection of methylprednisolone acetate in subacromial impingement syndrome. Study Design: Descriptive Case Series Place and Duration: Study was conducted in Orthopaedic Unit Ayub Medical Teaching Institute Abbottabad and MTI, Hayatabad Medical Complex Peshawar for one year duration from February 2020 to February 2021. Methods: Total 100 patients of newly diagnosed subacromial impingement syndrome were enrolled in this study. Patients were aged between 20-60 years. Patients details demographics age, sex and body mass index were recorded after taking informed written consent. Patients did not receive any treatment before were included. Effectiveness of intraarticular injection of methyl prednisolone acetate was measured by using visual analogue scale (VAS) for pain intensity from 0 to 10 by VAS score after 4 weeks.Completedata was analyzed by SPSS 22.0 version. Results: Mean age of the patients was 38.14±7.44 years with mean BMI 25.64±18.9kg/m2. Among 100 cases, 75 (75%) patients were males and 25 (25%) were females. Diabetic patients were 25 (25%) and 14 (14%) patients were gout among all cases. Mean VAS score before treatment was 6.14±4.84 and after treatment VAS score was reduced to 4.41± 3.64. After follow up of 4 weeks VAS score was decreased to 1.11±3.65. Satisfaction among patients were 90 (90%). Conclusion: We concluded in this study that for the treatment of subacromial impingement syndrome, intraarticularinjection of methylprednisolone acetate was effective and useful. It was also observed that VAS score among patients were reduced significantly with should pain. Keywords: Intra articular methylprednisolone injection, Subacromial impingement syndrome, Effectiveness, Visual analogue scale

Intraarticular Injection of Different Doses of Mesenchymal Stem Cell Derived Exosomes Reduces ATF-3 Expression in the Dorsal Root Ganglion in Monoiodoacetate-Induced Rats of Osteoarthritis

Background: This study aims to evaluate the therapeutic effect of intra-articular injection of different doses of exosomes derived from mesenchymal stem cells(MSC) and the effect on nerve and cartilage repair in a monoiodoacetate (MIA) model of knee osteoarthritis(OA) in rats. Methods: The pain rat model was established by injection of sodium monoiodate (MIA) into the knee joint of the rats, the knee joint and dorsal root ganglion (DRG) of rats were collected for histologic analyses. For pain assessment, On 1 day before MIA injection, 7, 14 days after MIA injection and 7, 14,28 days after Exosome injection,paw withdrawal threshold (PWT) and paw withdrawal latency (PWL) was measured. Articular cartilage were assessed on HE by ORASI grade and the expression of ATF-3 and GAP-43 in dorsal root ganglion (DRG) using immunohistochemistry and western blotting in MIA-induced rats. Results: In our study, exosome significantly improved PWT and PWL value with a dose-dependent manner on 7, 14, and 28 days after intra-articular Exosome compared with the MIA group. Exosome injection therapy also has a repairing effect on cartilage on 28 days after intra-articular Exosome compared with the MIA group. Moreover, exosome treatment significantly upregulated GAP-43 protein and downregulated ATF-3 protein in the DRG with a dose-dependent manner of the OA rat. Conclusion: Intraarticular injection of different doses of mesenchymal stem cell derived exosomes in MIA-induced rats osteoarthritis, the analgesic effect of exosome was dose-dependent. Moreover, the repair of nerve by exosomes is earlier than that of cartilage.

The Treatment of Bone Marrow Lesions Associated with Advanced Knee Osteoarthritis: Comparing Intraosseous and Intraarticular Injections with Bone Marrow Concentrate and Platelet Products

Background: Bone marrow lesions are a radiographic indication of bony pathology closely associated with advanced osteoarthritis of the adjacent joint. Injection of autologous orthobiologic products, including bone marrow concentrate and platelet-rich plasma, have demonstrated safety and efficacy in treating both advanced osteoarthritis (via intraarticular injection) and associated bone marrow lesions (via intraosseous injection). The relative efficacy of intraarticular versus intraosseous injection of orthobiologics has not been evaluated at the present time. Objectives: The objective was to evaluate differences in orthobiologic bone marrow lesions treatment, either as a collateral result of intraarticular injection with bone marrow concentrate and platelet products alone, or intraosseous plus intraarticular injection as measured by patient reported outcomes. Study Design: This study employed a prospective case-matched cohort design. Setting: This study took place at a single outpatient interventional orthopedic pain clinic. Methods: Using data from a prospective orthobiologic treatment registry of knee patients, a population of knee osteoarthritis with bone marrow lesions patients who had undergone only intraarticular knee injections of bone marrow concentrate and platelets (for symptomatic advanced osteoarthritis) were age, gender, and disease severity case-matched to a series of advanced osteoarthritis and bone marrow lesions patients who underwent intraosseous plus intraarticular injections. Self-reported patient outcomes for Numeric Pain Scale, International Knee Documentation Committee, lower extremity functional scale, and a modified single assessment numeric evaluation were compared between the 2 treatment groups. Results: Eighty patients were included, 40 in each group. Although pain and functional outcome scores were significantly improved in both treatment groups, there was no statistically significant differences in patient reported outcomes based on the type of treatment. Limitations: There are several limitations to this study, including multiple providers performing the injections, varying onset of symptoms to treatment, and additional injections after their initial treatment, that were not controlled. In addition, increasing the sample size may be beneficial as well, particularly with the large bone marrow lesions group, which did suggest possible improvement with intraosseous plus intraarticular over the intraarticular, although was not statistically significant in our sample. Limited data availability for this cohort as well as some missing data are other limitations to consider. Conclusion: Treating knee bone marrow lesions with intraosseous bone marrow concentrate and platelet products did not affect patient reported outcomes. Key words: Intraosseous, intraarticular, bone marrow concentrate, bone marrow lesion, bone marrow edema, knee osteoarthritis, platelet-rich plasma, injection