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

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.

Response to Comments by Zhao et al. Regarding “Knee Osteoarthritis: Clinical and MRI Outcomes After Multiple Intra-Articular Injections With Expanded Autologous Adipose-Derived Stromal Cells or Platelet-Rich Plasma”

“…We appreciate your comments and concerns and appreciate academically reaching out to us with an elegant letter and genuine interest in our article "Knee Osteoarthritis: Clinical and MRI Outcomes After Multiple Intra-Articular Injections With Expanded Autologous Adipose-Derived Stromal Cells or Platelet-Rich Plasma." 1 We agree with your concerns about the wide variety of platelet-rich plasma preparations and the lack of standardization. Likewise, recent systematic reviews have additionally found an alarming lack of reporting quality of the orthobiologics studies.…”

“…We appreciate your comments and concerns and appreciate academically reaching out to us with an elegant letter and genuine interest in our article “Knee Osteoarthritis: Clinical and MRI Outcomes After Multiple Intra-Articular Injections With Expanded Autologous Adipose-Derived Stromal Cells or Platelet-Rich Plasma.” 1…”

Hyaluronic acid, platelet-rich plasma, bone marrow aspirate concentrate, the stromal vascular fraction, or mesenchymal stem cells: which is the best candidate for treating knee osteoarthritis?

“…Belk et al (2023) reported no difference in outcome scores between PRP and BMAC, but both the PRP and BMAC outcome scores were better than those for patients receiving HA injection 46 . A recent study showed that autologously expanded AT-MSCs are better than PRP, especially at 12-and 24month follow-ups 47 . Bolia et al (2021) compared the clinical efficacy of BMAC and SVF for knee OA 48 based on 10 studies with 472 patients (233 patients with BMAC, 239 patients with SVF).…”