Osteoarthritis (OA) is the most common form of degenerative arthritis. It is characterized by breakdown of cartilage within the joint, which can lead to reduced mobility, inflammation, pain, and further degradation of other joint structures including bone and connective tissues. Because regenerative medicine modalities can target both the physical tissue damage and the inflammation that may occur in OA, they are a promising strategy for halting or even reversing the progression of this chronic disease.6,10
Benefits of Bone Marrow-derived Mesenchymal Stem Cells (MSCs) in Osteoarthritis
MSCs may be useful to repair joints damaged in OA through two key mechanisms that work together to promote healing: their anti-inflammatory action and their ability to recruit other healing-related cells to the area such as fibroblasts, epithelial cells and endothelial cells.6
Several case reports and pilot studies have observed the potential of bone marrow-derived MSCs as a treatment for cartilage lesions of the knee.1,7-9 One key study used a “biologic arthroplasty” approach to rebuilding degraded cartilage in the knees of 25 patients: a collagen matrix was seeded with MSCs and implanted into the damaged knee(s). This approach gave significant improvements in multiple clinical scores, and for 80% of patients their damaged cartilage was completely rebuilt.8 The same group also compared the use of MSCs (without any additional matrix) against matrix-induced autologous chondrocyte implantation (MACI) for the treatment of lesions in the patellofemoral portion of the knees of 37 patients, and again found that MSCs could fully rebuild the damaged regions in about 80% of cases.9
Platelet-rich Plasma (PRP) in Osteoarthritis (OA)
Several systematic reviews and meta-analyses have shown that PRP is a potential treatment option for knee OA. In a systematic review of 3 overlapping meta-analyses, authors reported that intra-articular PRP injections were more effective than either placebo or hyaluronic acid from 2 months post-injection up to a 12-month follow-up. Studies suggest that the use of PRP is safe, with minimal side effects.10 These meta-analyses are further supported by a recent randomized, double-blind, triple-parallel, placebo-controlled clinical trial that showed that PRP was more effective than hyaluronic acid or a control saline solution at improving joint function in 53 patients with mild to moderate OA of the knee.11 Although more studies should be conducted to continue to establish the clinical safety and efficacy of PRP in OA, the findings to date are encouraging and some clinicians now consider PRP to be a first-choice treatment for OA of the knee.12
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1. Gobbi A & Fishman M. Platelet-rich plasma and bone marrow-derived mesenchymal stem cells in sports medicine. Sports Med Arthrosc Rev 2016;24:69–73.
2. Hernigou P et al. Biologic augmentation of rotator cuff repair with mesenchymal stem cells during arthroscopy improves healing and prevents further tears: a case-controlled study. Int Orthop 2014;38:1811–1818.
3. Peerbooms JC et al. Positive effect of an autologous platelet concentrate in lateral epicondylitis in a double-blind randomized controlled trial: platelet-rich plasma versus corticosteroid injection with a 1-year follow-up. Am J Sports Med 2010;38:255–262.
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8. Gobbi A et al. One-step surgery with multipotent stem cells for the treatment of large full-thickness chondral defects of the knee. Am J Sports Med 2014;42:648–657
9. Gobbi A et al. Matrix-induced autologous chondrocyte implantation versus multipotent stem cells for the treatment of large patellofemoral chondral lesions: a nonrandomized prospective trial. Cartilage 2015;6:82–97.
10. Campbell KA et al. Does intra-articular platelet-rich plasma injection provide clinically superior outcomes compared with other therapies in the treatment of knee osteoarthritis? A systematic review of overlapping meta-analyses. Arthroscopy 2015;31:2213–2221.
11. Lin KY et al. Intra-articular injection of platelet-rich plasma is superior to hyaluronic acid or saline solution in the treatment of mild to moderate knee osteoarthritis: a randomized, double-blind, triple-parallel, placebo-controlled clinical trial. Arthroscopy 2019;35:106–117.
12. Cook CS et al. Clinical update: Why prp should be your first choice for injection therapy in treating osteoarthritis of the knee. Curr Rev Musculoskelet Med 2018;11:583–592.