Comparative outcomes of open-wedge high tibial osteotomy with platelet-rich plasma alone or in combination with mesenchymal stem cell treatment: a prospective study. Increased knee cartilage volume in degenerative joint disease using percutaneously implanted, autologous mesenchymal stem cells. Comparing the Chondrogenic Potential in vivo of Autogeneic Mesenchymal Stem Cells Derived from Different Tissues Intra-articular injection of mesenchymal stem cells for the treatment of osteoarthritis of the knee: a proof-of-concept clinical trial. Safety and complications reporting on the re-implantation of culture-expanded mesenchymal stem cells using autologous platelet lysate technique. Effect of adipose-derived mesenchymal stem and regenerative cells on lameness in dogs with chronic osteoarthritis of the coxofemoral joints: a randomized, double-blinded, multicenter, controlled trial.
PURPOSE This study compared the clinical results and second-look arthroscopic findings of patients undergoing open-wedge high tibial osteotomy ( HTO ) for varus deformity , with or without mesenchymal stem cell ( MSC ) therapy .  METHODS This prospect i ve , comparative observational study was design ed to evaluate the effectiveness of MSC therapy . The patients were divided into 2 groups : HTO with platelet-rich plasma ( PRP ) injection only ( n = 23 ) or HTO in conjunction with MSC therapy and PRP injection ( n = 21 ) . Prospect i ve evaluations of both groups were performed using the Lysholm score , Knee Injury and Osteoarthritis Outcome Score ( KOOS ) , and a visual analog scale ( VAS ) score for pain . Second-look arthroscopy was carried out in all patients at the time of metal removal . RESULTS The patients in the MSC-PRP group showed significantly greater improvements in the KOOS subscales for pain ( PRP only , 74.0 ± 5.7 ; MSC-PRP , 81.2 ± 6.9 ; P < .001 ) and symptoms ( PRP only , 75.4 ± 8.5 ; MSC-PRP , 82.8 ± 7.2 ; P = .006 ) relative to the PRP-only group . Although the mean Lysholm score was similarly improved in both groups ( PRP only , 80.6 ± 13.5 ; MSC-PRP , 84.7 ± 16.2 ; P = .357 ) , the MSC-PRP group showed a significantly greater improvement in the VAS pain score  ( PRP only , 16.2 ± 4.6 ; MSC-PRP , 10.2 ± 5.7 ; P < .001 ) . There were no differences in the preoperative ( PRP only , varus 2.8 ° ± 1.7 ° ; MSC-PRP , varus 3.4 ° ± 3.0 ° ; P = .719 ) and postoperative ( PRP only , valgus 9.8 ° ± 2.4 ° ; MSC-PRP , valgus 8.7 ° ± 2.3 ° ; P = .678 ) femorotibial angles or weight-bearing lines between the groups . Arthroscopic evaluation , at plate removal , showed that partial or even fibrocartilage coverage was achieved in 50 % of the MSC-PRP group patients but in only 10 % of the patients in the PRP-only group ( P < .001 ) . CONCLUSIONS MSC therapy , in conjunction with HTO , mildly improved cartilage healing and showed good clinical results in some KOOS subscores and the VAS pain score compared with PRP only . LEVEL OF EVIDENCE Level II , prospect i ve comparative study BACKGROUND The ability to repair tissue via percutaneous means may allow interventional pain physicians to manage a wide variety of diseases including peripheral joint injuries and osteoarthritis . This review will highlight the developments in cellular medicine that may soon permit interventional pain management physicians to treat a much wider variety of clinical conditions and highlight an interventional case study using these technologies OBJECTIVE To determine if isolated and exp and ed human autologous mesenchymal stem cells could effectively regenerate cartilage and meniscal tissue when percutaneously injected into knees . DESIGN Case Study SETTING Private Interventional Pain Management practice . METHODS An IRB approved study with a consenting volunteer in which mesenchymal stem cells were isolated and cultured ex-vivo from bone marrow aspiration of the iliac crest . The mesenchymal stem cells were then percutaneously injected into the subject 's knee with MRI proven degenerative joint disease . Pre- and post-treatment subjective visual analog pain scores , physical therapy assessment s , and MRIs  measured clinical and radiographic changes . RESULTS At 24 weeks post-injection , the patient had statistically significant cartilage and meniscus growth on MRI , as well as increased range of motion and decreased modified VAS pain scores . CONCLUSION The described process of autologous mesenchymal stem cell culture and percutaneous injection into a knee with symptomatic and radiographic degenerative joint disease result ed in significant cartilage growth , decreased pain and increased joint mobility in this patient . This has significant future implication s for minimally invasive treatment of osteoarthritis and meniscal injury Abstract Objective : To compare the chondrogenic ability of mesenchymal stem cells ( MSCs ) derived from different tissues in rabbits ’ full-thickness articular cartilage defects . Methods : Sixty New Zeal and white rabbits of ordinary grade with a body weight of 2.5∼3.5 kg were selected for this study . Six were sacrificed for preparation of deminerized bone matrix ( DBM ) as scaffold .  Fifty-four were used for cartilage defects model . Full-thickness cartilage defect of knee joint was created on trochlear groove at two sides of the femur with a diameter of 4 mm and thickness of 3 mm . All 54 rabbits were r and omly divided into 6 groups and treated by autogeneic MSCs isolated from bone marrow , periosteum , synovium , adipose tissue and muscle , respectively . The 6th group was a control group with nothing plugged into the defects . Every three rabbits were killed at three time points , which were 4 , 8 , and 12 weeks after the operation in each group . The reparative tissue sample s were evaluated grossly , histologically , immunohistochemically , and grade d according to gross and histological scales 12 weeks postoperatively . We input the scores into SPSS 11.5 software and the analysis of variance ( one-way-ANOVA ) and student-newman-keuls ( SNK-q ) test were used to process statistical analysis and find out if the differences between each group had statistical significance . Results : Fifty-four rabbits are included in the final analysis . The defects are all repaired by hyaline-like tissue except the control group . The bone-marrow-MSCs produced much more cartilage matrix than that of other groups . Gross and histological grading scale indicates that the defects repaired by MSCs isolated from bone marrow are superior to that repaired by MSCs isolated from periosteum , synovium , adipose tissue , and muscle ( p < 0.05 ) . In adipose-MSCs and muscle-MSCs group , some defects are even repaired by fibrous tissue . Conclusion : Bone-marrow-MSCs  have greater in vivo chondrogenic potential than periosteum- , synovium- , adipose- and muscle-MSCs Mesenchymal stem cells ( MSCs ) are known to have a potential for articular cartilage regeneration . However , most studies focused on focal cartilage defect through surgical implantation . For the treatment of generalized cartilage loss in osteoarthritis , an alternative delivery strategy would be more appropriate . The purpose of this study was to assess the safety and efficacy of intra-articular injection of autologous adipose tissue derived MSCs ( AD-MSCs ) for knee osteoarthritis  . We enrolled 18 patients with osteoarthritis of the knee and injected AD MSCs into the knee . The phase I study consists of three dose-escalation cohorts ; the low-dose ( 1.0 × 10(7 ) cells ) , mid-dose ( 5.0 × 10(7 ) ) , and high-dose ( 1.0 × 10(8 ) ) group with three patients each . The phase II included nine patients receiving the high-dose . The primary outcomes were the safety and the Western Ontario and McMaster Universities Osteoarthritis index ( WOMAC ) at 6 months . Secondary outcomes included clinical , radiological , arthroscopic , and histological evaluations . There was no treatment-related adverse event . The WOMAC score improved at 6 months after injection in the high-dose group . The size of cartilage defect decreased while the volume of cartilage increased in the medial femoral and tibial condyles of the high-dose group . Arthroscopy showed that the size of cartilage defect decreased in the medial femoral and medial tibial condyles of the high-dose group . Histology demonstrated thick , hyaline-like cartilage regeneration . These results showed that intra-articular injection of 1.0 × 10(8 ) AD MSCs into the osteoarthritic knee improved function and pain of the knee joint without causing adverse events , and reduced cartilage defects by regeneration of hyaline-like articular cartilage UNLABELLED ABSTRUCT : Mesenchymal stem cells ( MSCs ) hold great promise as therapeutic agents in regenerative medicine . Numerous animal studies have documented the multipotency of MSCs , showing their capabilities for differentiating into orthopedic tissues such as muscle , bone , cartilage , and tendon . However , the complication rate for autologous MSC therapy is only now beginning to be reported . METHODS Between 2005 and 2009 , two groups of patients were treated for various orthopedic conditions with culture-exp and ed , autologous , bone marrow-derived MSCs ( group 1 : n=45 ; group 2 : n=182 ) . Cells were cultured in monolayer culture flasks using an autologous platelet lysate technique and re-injected into peripheral joints ( n=213 ) or into intervertebral discs ( n=13 ) with use of c-arm fluoroscopy . While both groups had prospect i ve surveillance for complications , Group 1 additionally underwent 3.0 T MRI tracking of the re-implant sites . RESULTS Mean follow-up from the time of the re-implant procedure was 10.6 + /- 7.3 months . Serial MRI 's at 3 months , 6 months , 1 year and 2 years failed to demonstrate any tumor formation at the re-implant sites . Formal disease surveillance for adverse events based on HHS criteria documented 7 cases of probable procedure-related complications ( thought to be associated with the re-implant procedure itself ) and three cases of possible stem cell complications , all of which were either self-limited or were remedied with simple therapeutic measures . One patient was diagnosed with cancer ; however , this was almost certainly unrelated to the MSC therapy . CONCLUSIONS Using both high field MRI tracking and general surveillance in 227 patients , no neoplastic complications were detected at any stem cell re-implantation site . These findings are consistent with other reports that also show no evidence of malignant transformation in vivo , following implantation of MSCs that were exp and ed in vitro for limited periods Autologous stem cell therapy in the field of regenerative veterinary medicine involves harvesting tissue , such as fat , from the patient , isolating the stem and regenerative cells , and administering the cells back to the patient . Autologous adipose-derived stem cell therapy has been commercially available since 2003 , and the current study evaluated such therapy in dogs with chronic osteoarthritis of the hip . Dogs treated with adipose-derived stem cell therapy had significantly improved scores for lameness and the compiled scores for lameness , pain , and range of motion compared with control dogs . This is the first r and omized , blinded , placebo-controlled clinical trial reporting on the effectiveness of stem cell therapy in dogs
Osteoarthritis ( OA ) is one of the most common debilitating disorders among the elderly population .
At present , there is no definite cure for the underlying causes of OA .
However , adipose tissue-derived stem cells ( ADSCs ) in the form of stromal vascular fraction ( SVF ) may offer an alternative at this time .
ADSCs are one type of mesenchymal stem cells that have been utilized and have demonstrated an ability to regenerate cartilage .
ADSCs have been shown to regenerate cartilage in a variety of animal models also .
Non-culture-exp and ed ADSCs , in the form of SVF along with platelet rich plasma ( PRP ) , have recently been used in humans to treat OA and other cartilage abnormalities .
However , due to regulatory issues , only ADSCs in the form of SVF are currently allowed for clinical uses in humans .