Intra-articular injection of orthobiologics in patients undergoing high tibial osteotomy for knee osteoarthritis is safe and effective – a systematic review

Abstract

Purpose To qualitatively evaluate the current evidence reporting outcomes of intra-articular injection of orthobiologics in patients undergoing high tibial osteotomy (HTO) for osteoarthritis of the knee. Methods A systematic search methodology of the PUBMED, EMBASE, and CINAHL databases was conducted in July 2021. The search workflow was in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The following inclusion criteria were adopted: clinical trials of any level of evidence, reporting outcomes following intra-articular injection of orthobiologics during high tibial osteotomy for knee osteoarthritis, with a minimum number of 10 patients treated. Duplicate data, studies on implanted orthobiologics and articles not written in English were excluded from this review. Results Eight studies were included in this review, with a total of 585 patients. Outcomes were discussed based on the types of orthobiologics used: (i) Platelet-Rich Plasma (PRP), (ii) Bone Marrow Aspirate Concentrate (BMAC), and (iii) Injected Mesenchymal Stem Cells (MSCs). Two studies utilised PRP, 4 studies utilised BMAC and 4 studies utilised injected MSCs.. Three studies provided Level II evidence and five studies provided Level III evidence. Statistically significant improvements in outcomes were documented in multiple trials, with few patients experiencing adverse events. Conclusion Intra-articular injection of orthobiologics in patients undergoing HTO is safe and effective with good outcomes reported. Due to the lack of high-level evidence, further research is required before this can be considered standard of care. Level of evidence III

Differences in Synovial Cytokine Profile Associated with Long-Term Clinical Outcomes in Patients with Knee Osteoarthritis Undergoing Corrective Osteotomy with Platelet-Rich Plasma or Stromal Vascular Fraction Post-Treatments

“…PRP represents concentrated autologous human platelets in a small amount of plasma and contains major growth factors: platelet-derived growth factor (PDGF), basic fibroblast growth factor (FGF-2), vascular endothelial growth factor (VEGF), insulin growth factor (IGF)-1, and transforming growth factor (TGF) [ 9 ]. Intraarticular injection of orthobiologics such as PRP and mesenchymal stem cells (MSCs) in patients undergoing HTO has been shown to be safe and produced good clinical outcomes [ 10 ]. These MSCs were obtained either from autologous adipose tissue and injected into the patient’s knee as a part of SVF [ 11 , 12 ] or from the bone marrow, purified, enriched in culture up to 87–95% according to MSCs phenotypic markers followed by the injection into the knee [ 13 ].…”

Bone Marrow Aspirate Concentrate versus Human Umbilical Cord Blood-Derived Mesenchymal Stem Cells for Combined Cartilage Regeneration Procedure in Patients Undergoing High Tibial Osteotomy: A Systematic Review and Meta-Analysis

“…Therefore, many attempts have been made to combine HTO with several types of cartilage regeneration procedures to improve long-term outcomes. Among such procedures, augmentation using MSCs that can differentiate into chondrocytes and produce extracellular matrix molecules important for cartilage regeneration is a promising option for managing cartilage defects [ 40 ]. Because the etiology of knee OA involves both biomechanical and biochemical changes in knee articular cartilage, combining HTO and MSC augmentation procedures appears promising.…”

“…Various growth factors included in BMAC induce cartilage regeneration and provide a favorable environment for MSC adhesion [ 45 ]. The immune control and anti-inflammatory effects of BMAC also help restore cartilage [ 40 ]. In patients receiving HTO, microfractures treated with BMAC were reported to have better arthroscopic findings regarding cartilage recovery than microfractures not treated with BMAC [ 34 ]; however, limitations exist.…”

Using multivariate nonlinear mixed-effects model to investigate factors influencing symptom improvement after high tibial osteotomy in combination with bone marrow concentrate injection for medial compartment knee osteoarthritis: a prospective, open-label study

“…For medial opening wedge HTO, several studies have investigated the association of baseline demographic and radiographic features with clinical outcomes [ 19 – 23 ]. Although a few clinical studies and systematic reviews have investigated the efficacy of the combination of HTO and orthobiologics [ 24 – 26 ], few have reported and evaluated various structural, radiographic, and clinical factors that influenced the prognosis [ 27 ]. In our study, patients with medial compartment knee osteoarthritis were recruited.…”