Biomed Res Int. 2016;2016:4868613. doi: 10.1155/2016/4868613.

Combination of Intra-Articular and Intraosseous Injections of Platelet Rich Plasma for Severe Knee Osteoarthritis: A Pilot Study.

Sánchez M1, Delgado D2, Sánchez P2, Muiños-López E3, Paiva B4, Granero-Moltó F5, Prósper F6, Pompei O1, Pérez JC1, Azofra J1, Padilla S7, Fiz N1.
  • 1Arthroscopic Surgery Unit, Hospital Vithas San Jose, C/Beato Tomás de Zumarraga 10, 01008 Vitoria-Gasteiz, Spain.
  • 2Arthroscopic Surgery Unit Research, Hospital Vithas San Jose, C/Beato Tomás de Zumarraga 10, 01008 Vitoria-Gasteiz, Spain.
  • 3Cell Therapy Area, Clínica Universidad de Navarra, Avenida de Pío XII 36, 31008 Pamplona, Spain.
  • 4Center for Applied Medical Research, Avenida de Pío XII 55, 31008 Pamplona, Spain.
  • 5Cell Therapy Area, Clínica Universidad de Navarra, Avenida de Pío XII 36, 31008 Pamplona, Spain; Orthopaedic Surgery and Traumatology Department, Clínica Universidad de Navarra, Avenida de Pío XII 36, 31008 Pamplona, Spain.
  • 6Cell Therapy Area, Clínica Universidad de Navarra, Avenida de Pío XII 36, 31008 Pamplona, Spain; Hematology Department, Clínica Universidad de Navarra, Avenida de Pío XII 36, 31008 Pamplona, Spain.
  • 7Fundacion Eduardo Anitua, C/Jose María Cagigal 19, 01007 Vitoria-Gasteiz, Spain.

Abstract

The aim of this study was to assess a novel approach to treating severe knee osteoarthritis by targeting synovial membrane, superficial articular cartilage, synovial fluid, and subchondral bone by combining intra-articular injections and intraosseous infiltrations of platelet rich plasma. We explored a new strategy consisting of intraosseous infiltrations of platelet rich plasma into the subchondral bone in combination with the conventional intra-articular injection in order to tackle several knee joint tissues simultaneously. We assessed the clinical outcomes through osteoarthritis outcome score (KOOS) and the inflammatory response by quantifying mesenchymal stem cells in synovial fluid. There was a significant pain reduction in the KOOS from baseline (61.55 ± 14.11) to week 24 (74.60 ± 19.19), after treatment (p = 0.008), in the secondary outcomes (symptoms, p = 0.004; ADL, p = 0.022; sport/rec., p = 0.017; QOL, p = 0.012), as well as VAS score (p < 0.001) and Lequesne Index (p = 0.008). The presence of mesenchymal stem cells in synovial fluid and colony-forming cells one week after treatment decreased substantially from 7.98 ± 8.21 MSC/μL to 4.04 ± 5.36 MSC/μL (p = 0.019) and from 601.75 ± 312.30 to 139.19 ± 123.61  (p = 0.012), respectively. Intra-articular injections combined with intraosseous infiltrations of platelet rich plasma reduce pain and mesenchymal stem cells in synovial fluid, besides significantly improving knee joint function in patients with severe knee osteoarthritis. This trial is registered on EudraCT with the number 2013-003982-32.

PMID: 27462609

 

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