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. 2023 Dec;14(4):433-444.
doi: 10.1177/19476035231166127. Epub 2023 Jun 22.

Knee Osteoarthritis: Clinical and MRI Outcomes After Multiple Intra-Articular Injections With Expanded Autologous Adipose-Derived Stromal Cells or Platelet-Rich Plasma

Miguel A Khoury  1 , Karim Chamari  1 , Montassar Tabben  1 , Khalid Alkhelaifi  1 , Emmanuel Papacostas  1 , Theodorakys Marín Fermín  1 , Markus Laupheimer  1 , Pieter D Hooghe  1
Affiliations

Knee Osteoarthritis: Clinical and MRI Outcomes After Multiple Intra-Articular Injections With Expanded Autologous Adipose-Derived Stromal Cells or Platelet-Rich Plasma

Miguel A Khoury et al. Cartilage. 2023 Dec.

Abstract

Objective: To directly compare clinical and MRI outcomes of multiple intra-articular injections of adipose-derived stromal cells (ASCs) or platelet-rich plasma (PRP) in patients with knee osteoarthritis (OA).

Design: We retrospectively compared 24-month outcomes in (1) 27 patients receiving 3-monthly intra-articular injections with a total of 43.8 million ASCs and (2) 23 patients receiving 3-monthly injections of 3-ml preparation of PRP. All patients had Kellgren-Lawrence grade 1, 2, or 3 knee OA with failed conservative medical therapy. The Numeric Pain Rating Scale (NPRS) scores; Knee injury and Osteoarthritis Outcome Score (KOOS) at baseline, 6, 12, and 24 months after the first injection; and the MRI Osteoarthritis Knee Score (MOAKS) at 12 and 24 months were considered as outcomes.

Results: No major complications occurred in any patient. Both groups significantly improved in pain NPRS score and KOOS at 6 months. At 12- and 24-month evaluations, the ASC group significantly decreased scores to a greater degree (P < 0.001) than the PRP group. MOAKS scores indicated a decrease in disease progression in the ASC group.

Conclusion: Both ASCs and PRP were safe and resulted in clinical improvement in patients with knee OA at 6 months; however, at 12 and 24 months, ASCs outperformed leukocyte-poor PRP in clinical and radiological outcomes.

Keywords: adipose-derived stromal cells; cartilage injury; intra-articular injection; osteoarthritic knee pain; stem cells.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
NPR and KOOS subscales (symptom improvement, pain improvement, sport and recreation). NPR = Numeric Pain Rating Scale; KOOS = Knee Injury and Osteoarthritis Outcome Score; ADL = activities of daily living; QoL = quality of life.
Figure 2.
Figure 2.
MRI Fat saturated coronal image BML, MOAKS grade 3 (left) and 2 (right) in the medial knee compartment (white arrow) and lateral MOAKS grade 3 osteophytes without modification (blue arrow) after 24 months ASCs injections.
Figure 3.
Figure 3.
MRI fat-saturated sagittal image evaluating articular cartilage injury, MOAKS grade 2 (Left) and 0 (right) in medial knee compartment, weight-bearing region (white arrow) after 24 months ASCs injections.
Figure 4.
Figure 4.
MRI fat-saturated signal coronal image evaluating the distance between femur and tibia. Notice the increase in distance after 24 months of ASC injection therapy. ASC = adipose-derived stromal cell.
Figure 5.
Figure 5.
White arrow pointing at initial MOAKS grade 1 articular cartilage injury and bone marrow lesion in a PRP-treated patient. MOAKS = MRI Osteoarthritis Knee Score; PRP = platelet-rich plasma.
Figure 6.
Figure 6.
White arrow pointing at cartilage and bone marrow lesion in an MOAKS grade 2 injury. Progression of lesion in a PRP-treated patient. MRI at 24-month follow-up. MOAKS = MRI Osteoarthritis Knee Score; PRP = platelet-rich plasma.
See this image and copyright information in PMC

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