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Biologic Therapies for the Treatment of Knee Osteoarthritis
- Source :
- The Journal of Arthroplasty. 34:801-813
- Publication Year :
- 2019
- Publisher :
- Elsevier BV, 2019.
-
Abstract
- Background The use of biologic therapies for the management of knee osteoarthritis has increased, despite insufficient evidence of efficacy. Our aim was to complete a systematic review and analysis of reports utilizing the highest level-of-evidence evaluating: (1) platelet-rich plasma injections (PRPs); (2) bone marrow-derived mesenchymal stem cells (BMSCs); (3) adipose-derived mesenchymal stem cells (ADSCs); and (4) amnion-derived mesenchymal stem cells (AMSCs). Methods PubMed, Embase, and Cochrane Library databases were queried for studies evaluating PRP injections, BMSCs, ADSCs, and AMSCs in patients with knee osteoarthritis. Of 1009 studies identified within the last 5 years, 123 met inclusion criteria. A comprehensive analysis of all levels-of-evidence was performed, as well as separate analysis on level-of-evidence I studies. Level-of-evidence was determined by the American Academy of Orthopedic Surgeons classification system. Results Although the majority of PRP reports demonstrated improvements in pain and/or function, others revealed no substantial improvements. Similar findings were noted for BMSCs, ADSCs, and AMSCs. Assessments of BMSC studies yielded majority with positive clinical results, although short-lived. Studies on ADSCs revealed improved clinical outcomes, but equivocal radiographic outcomes. Studies evaluating AMSCs demonstrated improvements in pain and function, and decreased radiographic evidence of osteoarthritis. Conclusion Despite some promising early results for PRP, BMSC, ADSC, and AMSC therapies, the majority of level-of-evidence I studies have multiple problems: small sample sizes, potentially inappropriate control cohorts, short-term follow-up, and so on. Despite the limitations, there still appears to be evidence justifying their use for knee osteoarthritis management. More high-level, larger human studies utilizing standardized protocols are needed.
- Subjects :
- Oncology
medicine.medical_specialty
medicine.medical_treatment
Pain
Osteoarthritis
Cochrane Library
Mesenchymal Stem Cell Transplantation
Injections, Intra-Articular
03 medical and health sciences
0302 clinical medicine
Internal medicine
medicine
Humans
Orthopedics and Sports Medicine
In patient
030222 orthopedics
Platelet-Rich Plasma
business.industry
Mesenchymal stem cell
Biologic therapies
Mesenchymal Stem Cells
Small sample
Stem-cell therapy
Osteoarthritis, Knee
medicine.disease
Biological Therapy
Orthopedic surgery
business
Subjects
Details
- ISSN :
- 08835403
- Volume :
- 34
- Database :
- OpenAIRE
- Journal :
- The Journal of Arthroplasty
- Accession number :
- edsair.doi.dedup.....303c28b735d588f9119eea84eb3d7884