Adipose-derived Stem Cells for Knee Osteoarthritis
A second Arthroscopic look

 

Purpose

In the present study, the clinical outcomes and second-look arthroscopic findings of intra-articular injection of stem cells with arthroscopic lavage for treatment of elderly patients with knee osteoarthritis (OA) were evaluated.

Methods

Stem cell injections combined with arthroscopic lavage were administered to 30 elderly patients (≥65 years) with knee OA. Subcutaneous adipose tissue was harvested from both buttocks by liposuction. After stromal vascular fractions were isolated, a mean of 4.04 × 106 stem cells (9.7 % of 4.16 × 107 stromal vascular fraction cells) were prepared and injected in the selected knees of patients after arthroscopic lavage. Outcome measures included the Knee Injury and Osteoarthritis Outcome Scores, visual analog scale, and Lysholm score at preoperative and 3-, 12-, and 2-year follow-up visits. Sixteen patients underwent second-look arthroscopy.

Results

Almost all patients showed significant improvement in all clinical outcomes at the final follow-up examination. All clinical results significantly improved at 2-year follow-up compared to 12-month follow-up (P < 0.05). Among elderly patients aged >65 years, only five patients demonstrated worsening of Kellgren–Lawrence grade. On second-look arthroscopy, 87.5 % of elderly patients (14/16) improved or maintained cartilage status at least 2 years postoperatively. Moreover, none of the patients underwent total knee arthroplasty during this 2-year period.

The findings of a 67-year old woman during the first and second arthroscopy procedure showed marked changes in cartilage defects of the medial femoral condyle (Fig. 4).

chrondral defect

The mean Lysholm score significantly increased from 54.3 ± 15.4 to 74.2 ± 13.4 (P < 0.05). The mean VAS decreased from 4.7 ± 1.6 preoperatively to 1.7 ± 1.4 at 2-year follow-up (P < 0.05). The median KOOS from preoperative to 2-year follow-up assessments is summarized in Fig. 2. Moreover, all clinical results significantly improved at 2-year follow-up compared to those at 1-year follow-up (P < 0.05). With regard to overall patient satisfaction with the operation, 16 patients reported their satisfaction as excellent (53 %), 7 as good (23 %), 4 as fair (13 %), and 3 as poor (10 %). At 2-year follow-up, the K–L grade in five patients increased by one grade. The K–L grade in two patients increased from grade 2 to 3, whereas the K–L grade in three patients increased from grade 3 to 4. However, no patients underwent a second operation such as total knee arthroplasty. No major complications associated with arthroscopic lavage and liposuction, either intraoperatively or postoperatively, were observed in this series. In three patients, slight knee pain was experienced in the first week after the stem cell injection, which resolved spontaneously in two patients in 1 week with no medication and resolved after 2 weeks in the other patient with anti-inflammatory drug medication.

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KOOS profiles prior to and up to 2 years after stem cell therapy. Mean KOOS scores (n = 30) at the preoperative, 3-, 12-month and 2-year assessments after MSC therapy. At all follow-up point, differences in the values were statistically significant (P < 0.05) compared with the preoperative status. ADL activities of daily living, sports/recr sports and recreation, QoL quality of life

Conclusion

Adipose-derived stem cell therapy for elderly patients with knee OA was effective in cartilage healing, reducing pain, and improving function. Therefore, adipose-derived stem cell treatment appears to be a good option for OA treatment in elderly patients.

Published 11 December 2013
REF: Koh, Y., Choi, Y., Kwon, S., Kim, Y. and Yeo, J. (2013). Clinical results and second-look arthroscopic findings after treatment with adipose-derived stem cells for knee osteoarthritis. Knee Surgery, Sports Traumatology, Arthroscopy, 23(5), pp.1308-1316.