Knee Osteoarthritis: Clinical and MRI Outcomes After Multiple Intra-Articular Injections With Expanded Autologous Adipose-Derived Stromal Cells or Platelet-Rich Plasma.

OBJECTIVE: To directly compare clinical and MRI outcomes of multiple intra-articular injections of adipose-derived stromal cells (ASCs) or platelet-rich plasma (PRP) in patients with knee osteoarthritis (OA). DESIGN: We retrospectively compared 24-month outcomes in (1) 27 patients receiving 3-monthly intra-articular injections with a total of 43.8 million ASCs and (2) 23 patients receiving 3-monthly injections of 3-ml preparation of PRP. All patients had Kellgren-Lawrence grade 1, 2, or 3 knee OA with failed conservative medical therapy. The Numeric Pain Rating Scale (NPRS) scores; Knee injury and Osteoarthritis Outcome Score (KOOS) at baseline, 6, 12, and 24 months after the first injection; and the MRI Osteoarthritis Knee Score (MOAKS) at 12 and 24 months were considered as outcomes. RESULTS: No major complications occurred in any patient. Both groups significantly improved in pain NPRS score and KOOS at 6 months. At 12- and 24-month evaluations, the ASC group significantly decreased scores to a greater degree (P < 0.001) than the PRP group. MOAKS scores indicated a decrease in disease progression in the ASC group. CONCLUSION: Both ASCs and PRP were safe and resulted in clinical improvement in patients with knee OA at 6 months; however, at 12 and 24 months, ASCs outperformed leukocyte-poor PRP in clinical and radiological outcomes.

Expanded adipose derived mesenchymal stromal cells are effective in treating chronic insertional patellar tendinopathy: clinical and MRI evaluations of a pilot study.

PURPOSE: Effect of ultrasound guided injections of autologous ASCs in chronic recalcitrant patellar tendinopathy. METHODS: Fourteen patients (16 knees, 12/2 males/females) with chronic, recalcitrant (unsuccessfully treated with nonoperative treatments) insertional PT underwent clinical evaluation and magnetic resonance imaging (MRI) before intervention. Stromal vascular fraction cells (SVF) were expanded by in-vitro culture and characterized by flow cytometry. Players were injected with three bi-weekly injections of ASCs followed by physiotherapy. They underwent serial clinical evaluations during a 12-month period with repeated MRI at 6-month post-injection. RESULTS: Victorian Institute of sports assessment-patellar tendon questionnaire (VISA-P) scores improved from 43.8 ± 4.9 at baseline to 58.1 ± 7.1, 70.3 ± 7.9 and 78.7 ± 7.5 at 3, 6, and12months follow-up, respectively. (p = 0.0004 comparing each variable with the previous one). Mean Visual analogue pain in sports (VAS-sport) score during practice significantly decreased from 7.4 ± 0.5 at baseline to 5.2 ± 1.5 9 (p = 0.0005), 3.3 ± 1.1 (p = 0.0004) and 1.5 ± 0.7 (P = 0.0004) at 3, 6, and 12 months, respectively. Mean Tegner-scores for patients were 8.0 ± 0.8 before injury and 2.3 ± 0.9 before treatment, thereafter, improving to 4.8 ± 0.8 and 7.2 ± 0.7 at 6- and 12- months, respectively (p = 0.0001). MRI assessed tendon width' did not change over the first 6 months post-intervention. Significant changes were observed for: tendon thickness (12.8 ± 1.1 to 10.9 ± 0.7, P = 0.0001); tear length (9.3 ± 1.3 to 2.3 ± 0.7, P = 0.0001), tear width (6.3 ± 0.8 to 3.4 ± 0.4, P = 0.0001), and tear thickness (4.6 ± 0.4 to 2.6 ± 0., P = 0.0001) at baseline and 6 months, respectively. CONCLUSION: Patients with recalcitrant insertional PT showed significant clinical improvement and structural repair at the patellar insertional tendinopathy after injections of autologous ASCs. Results of this study are promising and open a new biological therapeutic modality to treat PT.

Tratamiento de la artrosis de rodilla con deformidades angulares

Se hacen consideraciones sobre la etiopatogenia de la artrosis con deseje, encaminadas a la interpretación signosintomatológica y orientadas hacia la terapéutica. Se enumeran los criterios de indicación y las restricciones de la misma en las osteotomías correctoras del eje. Acerca de ella se menciona la importancia de lograr una adecuada corrección que asegure en el tiempo sus efectos beneficiosos, siendo los pilares del mismo la cuidadosa planificación preoperatoria y la correcta ejecución de la técnica. Tanto para el tratamiento del genu varo, como para el del genu valgo, el concepto más relevante es descargar el compartimiento predominantemente afectado transfiriendo la carga al normal o menos afectado. Para la artrosis del compartimiento medial se logra hipercorrigiendo el ángulo femorotibial en 5 grados. Para la artrosis del compartimiento lateral, el objetivo debe ser dejar una rodilla con un eje comprendido entre 0 grado y el valgo fisiológico. Se plantea el nivel de realización de las osteotomías varizantes y valguizantes y se examinan sucintamente las diferentes técnicas

Tratamiento de la artrosis de rodilla con deformidades angulares

Se hacen consideraciones sobre la etiopatogenia de la artrosis con deseje, encaminadas a la interpretación signosintomatológica y orientadas hacia la terapéutica. Se enumeran los criterios de indicación y las restricciones de la misma en las osteotomías correctoras del eje. Acerca de ella se menciona la importancia de lograr una adecuada corrección que asegure en el tiempo sus efectos beneficiosos, siendo los pilares del mismo la cuidadosa planificación preoperatoria y la correcta ejecución de la técnica. Tanto para el tratamiento del genu varo, como para el del genu valgo, el concepto más relevante es descargar el compartimiento predominantemente afectado transfiriendo la carga al normal o menos afectado. Para la artrosis del compartimiento medial se logra hipercorrigiendo el ángulo femorotibial en 5 grados. Para la artrosis del compartimiento lateral, el objetivo debe ser dejar una rodilla con un eje comprendido entre 0 grado y el valgo fisiológico. Se plantea el nivel de realización de las osteotomías varizantes y valguizantes y se examinan sucintamente las diferentes técnicas