The role of arthroscopy in intra‐articular adipose tissue‐derived mesenchymal stem cells for the treatment of early‐stage knee osteoarthritis: A bicentric retrospective comparative study

TL;DR

This study compares the effectiveness of arthroscopy combined with stem cell treatment versus stem cells alone for early knee osteoarthritis.

Contribution

The study provides new evidence that arthroscopy combined with AD-MSCs improves long-term outcomes compared to AD-MSCs alone.

Findings

Patients who received arthroscopy and AD-MSCs had better WOMAC and functionality scores at 5 years.

Seventy-two patients (53%) had good symptomatic control at 5 years after AD-MSCs injection.

Conservative re-intervention rates were comparable between the two groups.

Abstract

To determine the difference in clinical scores and re‐intervention rates in patients receiving intra‐articular adipose‐derived mesenchymal stromal cells (AD‐MSCs) as a stand‐alone treatment for knee osteoarthritis (OA) compared to patients receiving the same treatment following arthroscopic debridement and lavage.

Internal records at two orthopaedic centres were reviewed, and all consecutive patients with Kellgren–Lawrence II–III knee OA who had received intra‐articular AD‐MSC during 2017–2018 were included. The patients were stratified into two cohorts depending on whether they also received debridement arthroscopy. Patients were evaluated with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and visual analogue scale (VAS) scores as well as re‐intervention rates with a last available follow‐up of 5 years after the intra‐articular AD‐MSC injection.

A total of 135 patients were enroled, 66 (49%) patients were male and 69 (51%) were female. The mean age at the time of intervention was 66 (range: 43–81) years. About half of the cohort (n = 68) received a diagnostic and therapeutic arthroscopy (intervention) procedure in the same setting, whereas the other half (n = 67) received intra‐articular AD‐MSCs without an arthroscopic procedure (control). Totally, 94% reported improved VAS scores post‐operatively. Seventy‐two patients (53%) had good symptomatic control at 5 years after the intra‐articular AD‐MSCs injection (VAS score range 0–3). Within this group, 57% of the patients had also received arthroscopy as part of their treatment, whereas the remaining patients had only received the intra‐articular injection of AD‐MSCs. Overall, WOMAC (46 arthroscopy + AD‐MSC, 58 AD‐MSC, p < 0.0001) and functionality (34 arthroscopy + AD‐MSC, 43 AD‐MSC, p < 0.0001) scores were superior in the cohort who also received debridement arthroscopy at the 5‐year follow‐up. Conservative re‐intervention rates, such as hyaluronic acid injections, were comparable amongst the cohorts.

Overall, debridement arthroscopy with AD‐MSC is favoured over stand‐alone MSC in Kellgren–Lawrence I–III knee OA.

Level III, retrospective comparative study.