A. Di Martino (Bologna, IT)
Rizzoli Orthopaedic Institute IX DivisionPresenter Of 3 Presentations
16.1.7 - ADSCs vs PRP in patients with knee Osteoarthritis: Preliminary results of a Randomized Controlled Trial.
Abstract
Purpose
The aim of this study is to evaluate, through a single-blind randomized controlled trial (RCT), the benefit provided by micro-fragmented adipose-derived mesenchymal stem cells (ADSCs) to treat symptomatic knee osteoarthritis (OA) in comparison with a single injection of platelet-rich plasma (PRP), one of the most studied injective treatment currently adopted for this condition.
Methods and Materials
A total of 118 patients were treated with a single intra-articular injection (59 treated with ADSCs and 59 with PRP). Patients were enrolled according to the following inclusion criteria: male or female with age > 18 and < 75; symptomatic knee OA with Kellgren-Lawrence grade of 1-4; failure of at least one conservative treatment for OA knee pain. Up-to-date, 70 patients (35 ADSCs and 35 PRP) were prospectively evaluated up to 6 months after treatment using IKDC subjective, EQ-VAS, and KOOS scores.
Results
At 6 months’ follow-up, both groups presented a significant clinical improvement for all scores. The IKDC subjective score improved from 40.4 to 56.6 in ADSCs group, and from 41.4 to 55.7 in PRP group; the mean EQ-VAS in ADSCs group improved from 64.4 to 71.9, and from 66.0 and 74.3 in PRP group; the KOOS pain improved from 61.0 to 75.9 in the ADSCs group and from 61.5 to 74.1 in the PRP group, and a similar trend was observed also for the other KOOS subscales. No statistically significant difference was found between the two groups at 6 months follow-up.
Conclusion
The preliminary results of this RCT between ADSCs and PRP showed a significant improvement for both groups at 6 months’ follow-up, without any significant difference between the two groups. The analysis of all included patients at the planned 2 years follow-up is needed to confirm these results, in order to provide evidence-based suggestions about the use of ADSCs for the treatment of knee OA.
16.3.5 - Platelet-rich Plasma for the Treatment of Sport-active Patients with Knee Osteoarthritis: Limited Return to Sport.
Abstract
Purpose
In the last years, platelet-rich plasma (PRP) has been proposed for the treatment of knee osteoarthritis and its use is now supported by increasing evidences. Although recent reviews and meta-analysis showed good results using PRP for the treatment of knee osteoarthritis, the literature is still sparse on the use of PRP for the treatment of active patients. Aim of this study is to evaluate a cohort of sport-active patients suffering from cartilage degeneration and OA, in terms of clinical outcome and return to sport (RTS) after PRP injective treatment.
Methods and Materials
The study included forty-seven sport-active patients ≤50 years old with unilateral symptomatic knee cartilage degeneration or osteoa. Patients received 3 PRP injections and were prospectively evaluated at baseline and then at 2, 6, 12, and 24 months follow-up by IKDC subjective EQ-VAS, and Tegner scores. Furthermore, patients were asked about their return to sport, both in terms of return to any sport level or to their activity level before symptoms onset.
Results
IKDC subjective score improved significantly at all follow-ups, changing from 59.2±13.6 to 70.6±13 at 12 months and 76.7±12.5 at 24 months. A similar outcome was observed with the EQ-VAS score. Tegner score improved from 3.6±1.4 to 4.8±0.9 at 24 months, but only 76.6% of patients returned to some kind of sport activity and 48.9% to the same activity level. A lower pre-symptoms Tegner score was associated with a higher return to sport rate, both at any level and at the same level.
Conclusion
Sport-active patients affected by knee osteoarthritis can benefit from PRP injections, with pain and function improvement. However, results are less satisfactory in terms of return to sport since only half can achieve the same sport level as before the onset of symptoms. Patients undergoing PRP treatment should be aware of their low chances to go back to high-impact sport activities.
18.1.6 - A treatment for chondral and osteochondral knee defects: clinical results of a biomimetic scaffold implantation at 3 years' follow-up.
Abstract
Purpose
Different approaches have been proposed to treat osteochondral defects. Among them, researches are recently focusing on the role of subchondral bone with regard to articular surface disease, with new specifically developed bioengineered strategies. Aim of this study is to evaluate the clinical and MRI outcome after the implantation of a nanostructured biomimetic collagen-hydroxyapatite construct for the treatment of chondral and osteochondral defects of the knee in a large cohort of patients.
Methods and Materials
One hundred twenty patients (85 men, 35 women), affected by grade III-IV femoral condyle or trochlea chondral lesions or osteochondritis dissecans (OCD) were consecutively treated. The mean age was 31.0±11.1 years, the mean lesion size was 3.5±2.3 cm2. Seventy patients had undergone previous surgeries, whereas concurrent procedures were necessary in sixty-one cases. The clinical outcome was evaluated using the IKDC and Tegner scores at 12 and 36 months of follow-up. At follow-up times a MRI was performed and evaluated with the MOCART score.
Results
All the scores improved significantly: IKDC score increased from the baseline to 12 months of follow-up (46.0±16.6 to 70.9±16.9, p<0.005), with a slight further increase up to 36 months’ follow-up (74.1±21.2, n.s.). Tegner score increased significantly but the pre-injury activity level wasn’t recovered. Six patients (5%) failed the treatment and were re-operated for the same reason. Patients affected by OCD had better clinical improvement than those with degenerative lesions. Some abnormal MRI findings were present, even though no correlation was found with the clinical outcome.
Conclusion
This one-step biomimetic approach developed to favor osteochondral tissue regeneration is effective in treating knees affected by damages of the articular surface, leading to a significant clinical improvement. However, abnormal MRI findings were present, even if not correlated with the clinical outcome.