Mesenchymal Stem Cell Injections Improve Symptoms of Knee Osteoarthritis

Published:January 31, 2013DOI:https://doi.org/10.1016/j.arthro.2012.11.017

      Purpose

      The purpose of this study was to evaluate the clinical and imaging results of patients who received intra-articular injections of autologous mesenchymal stem cells for the treatment of knee osteoarthritis.

      Methods

      The study group comprised 18 patients (6 men and 12 women), among whom the mean age was 54.6 years (range, 41 to 69 years). In each patient the adipose synovium was harvested from the inner side of the infrapatellar fat pad by skin incision extension at the arthroscopic lateral portal site after the patient underwent arthroscopic debridement. After stem cells were isolated, a mean of 1.18 × 10 6 stem cells (range, 0.3 × 10 6 to 2.7 × 10 6 stem cells) were prepared with approximately 3.0 mL of platelet-rich plasma (with a mean of 1.28 × 10 6 platelets per microliter) and injected into the selected knees of patients. Clinical outcome was evaluated with the Western Ontario and McMaster Universities Osteoarthritis Index, the Lysholm score, and the visual analog scale (VAS) for grading knee pain. We also compared magnetic resonance imaging (MRI) data collected both preoperatively and at the final follow-up.

      Results

      Western Ontario and McMaster Universities Osteoarthritis Index scores decreased significantly ( P < .001) from 49.9 points preoperatively to 30.3 points at the final follow-up (mean follow-up, 24.3 months; range, 24 to 26 months). Lysholm scores also improved significantly ( P < .001) by the last follow-up visit, increasing from a mean preoperative value of 40.1 points to 73.4 points by the end of the study. Likewise, changes in VAS scores throughout the follow-up period were also significant ( P = .005); the mean VAS score decreased from 4.8 preoperatively to 2.0 at the last follow-up visit. Radiography showed that, at the final follow-up point, the whole-organ MRI score had significantly improved from 60.0 points to 48.3 points ( P < .001). Particularly notable was the change in cartilage whole-organ MRI score, which improved from 28.3 points to 21.7 points ( P < .001). Further analysis showed that improvements in clinical and MRI results were positively related to the number of stem cells injected.

      Conclusions

      The results of our study are encouraging and show that intra-articular injection of infrapatellar fat pad–derived mesenchymal stem cells is effective for reducing pain and improving knee function in patients being treated for knee osteoarthritis.

      Level of Evidence

      Level IV, therapeutic case series.
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      Linked Article

      • Mesenchymal Stem Cells Versus Fat Pad–Derived Cells
        ArthroscopyVol. 30Issue 4
        • In Brief
          We read the article “Mesenchymal Stem Cell Injections Improve Symptoms of Knee Osteoarthritis” in the April 2013 issue of your highly acclaimed journal with great interest.1 We congratulate Koh et al. for their work, but we are very concerned about the erroneous use of the term “fat pad–derived mesenchymal stem cells (MSCs)” instead of “fat pad aspirate concentrate” or “fat pad–derived cells” (probably containing a small number of mesenchymal stem cells) in the article. It leads to serious confusion for the readers including ourselves.
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