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Intra-articular injections of expanded mesenchymal stem cells with and without addition of platelet-rich plasma are safe and effective for knee osteoarthritis

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To compare the effectiveness and safety of intra-articular injections of autologous expanded mesenchymal stromal stem cells alone (MSCs), or in combination with platelet-rich plasma (MSCs + PRP), in patients with knee osteoarthritis.

Methods

Eighteen patients (57.6 ± 9.6 years) with radiographic symptomatic knee osteoarthritis (Dejour grades II–IV) were randomized to receive intra-articular injections of MSCs (n = 9) or MSCs + PRP (n = 9). Injections were performed 2–3 weeks after bone marrow aspiration (± 80–100 ml) which was obtained from both posterior iliac crests.

Results

The Knee Injury and Osteoarthritis Outcome Score (KOOS) improved significantly throughout the 12 months for both groups (p < 0.05). No statistically significant differences between groups were found in KOOS subscales and global score improvements at 12-month end-point (n.s.). The MSCs group showed significant improvements in the pain, function and daily living activities, and sports and recreational activities subscales (p < 0.05). Similarly, the MSCs + PRP group showed significant improvements in the pain, function and daily living activities and quality of life subscales (p < 0.05). The average number of fibroblast colony forming units (CFU-F) was 56.8 + 21.9 for MSCs group and 50.7 ± 21.7 for MSCs + PRP group. Minimal adverse effects were seen in both groups (10 adverse events, in 5 patients).

Conclusions

Intra-articular injections of expanded MSCs alone or in combination with PRP are safe and have a beneficial effect on symptoms in patients with symptomatic knee osteoarthritis. Adding PRP to the MSCs injections did not provide additional benefit. These results are encouraging and support the recommendation of this minimally invasive procedure in patients with knee osteoarthritis, without requiring hospitalization. The CFU-F results may be used as reference for future research.

Level of evidence

Prospective cohort study, Level II.

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Funding

This study was funded by ESHO Empresa de Serviços Hospitalares S.A. (Grant number: not applicable).

Author information

Authors and Affiliations

  1. Clínica do Dragão, Espregueira-Mendes Sports Centre-FIFA Medical Centre of Excellence, Rua Futebol Clube do Porto, Estádio do Dragão, Entrada Nascente, Piso-3, Porto, Portugal

    Ricardo Bastos, Renato Andrade & João Espregueira-Mendes

  2. Universidade Federal Fluminense, Nireói, Rio de Janeiro, Brazil

    Ricardo Bastos, Marcelo Mathias & Vinicius Schott

  3. Dom Henrique Research Centre, Porto, Portugal

    Ricardo Bastos, Renato Andrade & João Espregueira-Mendes

  4. Faculty of Sports, University of Porto, Porto, Portugal

    Renato Andrade

  5. Hospital Lusíadas, Porto, Portugal

    Raquel Bastos

  6. Excellion, Nireói, Rio de Janeiro, Brazil

    Alex Balduino

  7. Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, New York, NY, USA

    Scott Rodeo

  8. 3B’s Research Group-Biomaterials, Biodegradables and Biomimetics, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, University of Minho, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017, Guimarães, Portugal

    João Espregueira-Mendes

  9. ICVS/3B’s-PT Government Associate Laboratory, Braga/guimarães, Portugal

    João Espregueira-Mendes

  10. Orthopaedics Department of Minho University, Braga, Portugal

    João Espregueira-Mendes

Authors
  1. Ricardo Bastos
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  2. Marcelo Mathias
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  8. João Espregueira-Mendes
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Corresponding author

Correspondence to Ricardo Bastos.

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Conflict of interest

The authors declare that this study received funding from ESHO Empresa de Serviços Hospitalares S.A. Ricardo Bastos received grants from ESHO Empresa de Serviços Hospitalares S.A. The others authors declare no conflict of interest.

Ethical approval

The research was approved by the Comissão Nacional de Ética em Pesquisa (Brazilian National Ethics in Research Committee)—CONEP, under number 14878813.4.0000.5533 and was conducted in accordance with the principles of the Declaration of Helsinki.

Informed consent

All the participants signed the written consent form before inclusion in the study.

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Bastos, R., Mathias, M., Andrade, R. et al. Intra-articular injections of expanded mesenchymal stem cells with and without addition of platelet-rich plasma are safe and effective for knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 26, 3342–3350 (2018). https://doi.org/10.1007/s00167-018-4883-9

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  • DOI: https://doi.org/10.1007/s00167-018-4883-9

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