Abstract
BackgroundCell-based therapies have shown promise for the treatment of knee osteoarthritis (OA). The current study compared exercise therapy to autologous bone marrow concentrate (BMC) and platelet products for knee OA treatment.MethodsPatients with symptomatic knee OA (N = 48) were randomized into either an exercise therapy control group or treatment group with injection of autologous BMC and platelet products. Patients in the control group could crossover to BMC treatment after 3 months. Clinical outcomes were documented at baseline and at 6-weeks, 3, 6, 12 and 24 months, including the Knee Society Score (KSS), Pain Visual Analogue Scale, Short Form-12 Scales (SF-12), and Lower Extremity Activity Scale (LEAS).ResultsAll patients in the exercise group crossed over to receive BMC treatment after 3 months (N = 22 crossover). At 3 months, KSS-knee, SF-12 Physical, and LEAS improved significantly in the crossover group compared to exercise, similar to significant improvements on KSS-knee and LEAS for the treatment group (N = 26) compared to exercise group at 3 months. After BMC treatment, patients’ clinical outcome scores (except SF-12 Mental Health), were significantly improved through the 2-year follow-up compared to baseline. No serious adverse events were reported.ConclusionThe use of image-guided percutaneous BMC with platelet products yielded better results than exercise therapy as an effective alternative therapy for patients with symptomatic moderate to moderate-severe osteoarthritis of the knee.Trial registration NCT02034032. https://clinicaltrials.gov/ct2/show/NCT02034032. Registered 13 January 2014
Highlights
Cell-based therapies have shown promise for the treatment of knee osteoarthritis (OA)
In the present investigation we describe a randomized controlled trial of a specific protocol of image guided percutaneous injection of a combination of bone marrow concentrate (BMC) and platelet products versus an exercise therapy regimen among patients with moderate knee osteoarthritis
The BMC treatment group received an injection of autologous BMC and platelet products, and the control group underwent a home exercise therapy program following instruction in knee strengthening and stability exercises
Summary
Cell-based therapies have shown promise for the treatment of knee osteoarthritis (OA). Osteoarthritis (OA) is one of the most common causes of chronic joint pain. Conservative treatment options for painful knee OA aimed at controlling pain and improving function, are often unsatisfactory. Treatment modalities include pharmacologic agents, physical therapy, and injections. The most common pharmaceutical therapies for knee OA include non-steroidal anti-inflammatory drugs (NSAIDs), which are not curative and associated with side effects when used long term, including upper gastrointestinal complications and increased risk of cardiovascular events [3]. Exercise or physical therapy including aerobic walking and strengthening exercises has been shown to improve function and reduce pain compared to control groups [4, 5], while aquatic therapies provide short term benefits [6]. Invasive injection procedures for OA such as corticosteroid injections only demonstrate modest clinical benefits without altering disease progression and may increase the rate of cartilage loss [7]
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