Patellofemoral Osteoarthritis: Treatment with Autologous Bone Marrow Mononuclear Cells and Arthroscopic Surgery, a Prospective Study

Abstract

Objective: The aim of this study was to evaluate the treatment using BMMCs and arthroscopy in PF OA through functional questionnaires and MRI evaluations in a two year follow up. The use of mononuclear cells derived from bone marrow (BMMCs) is under investigation, and in vitro and pre-clinic studies showed promisor results. In comparison to the mesenchymal stem cells (MSC), the effectiveness is lower, however the costs for manipulation and laboratory handling make it difficult to use in clinical practice. Design: This was a pilot, longitudinal and prospective trial and 8 patients with patellofemoral osteoarthritis who met the study criteria were included. All of the patients underwent arthroscopic debridement and received an injection of autologous BMMCs. Clinical outcomes were evaluated using SF-36 and the TLKSS questionnaire at baseline, one and two years after the procedure. Results: In this study, an improvement in all of the evaluated parameters of the questionnaire was verified even after two years following the applications. The functional score of TKLSS showed a significant improvement in one and two years in comparison to the baseline (p<0.001). A significant improvement in SF-36 for all of the domains (p<0.001) was also verified. In addition, an improvement in the MRI images of the patients was noticed, which indicates patellar cartilage recovery. Conclusion: The procedure of the arthroscopy and the application of BMMCs has proved promising results to reduce the signs of PF OA and ensure the patient satisfaction with a safe return to social life and sports practice. The completed questionnaire confirmed a clear improvement and a strong impact on the quality of life of the patients with the regeneration of their articular cartilage and restored subchondral bone. These results offer a wide perspective for future studies with the use of BMMC to treat articular diseases.

Intraarticular injection of microfragmented adipose tissue plus arthroscopy in isolated primary patellofemoral osteoarthritis is clinically effective and not affected by age, BMI, or stage of osteoarthritis

“…On the other hand, Guimaraes et al. [ 14 ] reported the results at 2 years of follow-up, but only eight patients were treated and with different doses (range, 30–87 ml) of bone marrow mononuclear cells, while in the present study 23 patients received a standard (and recognized) dose of 10–15 ml of microfragmented adipose tissue.…”

“…Existing literature lacks evidence on the results in patients with isolated primary PFOA treated with autologous microfragmented adipose tissue injection, focusing on results obtained in patients with generic knee OA [ 17 , 28 ]. To our knowledge, only three studies have been previously published on alternative joint-preservation treatments of isolated primary PFOA: the first of these reported the results of concomitant intraarticular injection of MSCs and PRP [ 32 ], the second evaluated the efficacy and safety of autologous protein solution injection [ 36 ], the third evaluated treatment with autologous bone marrow mononuclear cells injection associated with arthroscopic debridement [ 14 ]. However, Pintat et al.…”

Impact on the quality of life of patients suffering from osteoarthritis of the knee after intra-articular administration of bone marrow mononuclear cells

“…The number of cells used increased 3 folds basal number, reaching 35.2 x 10 6 cells /mL [8]. We published a study evaluating the use of BMMCs and arthroscopy to treat patellofemoral osteoarthritis and verified promising results, reducing signs of patellofemoral AO and ensure the patient satisfaction with a safe return to social life and sports and improvement in functional scores, restoring the articular cartilage of subchondral bone [9]. However, the use of BMMCs for OA is not patient.…”