Intra-Articular Cellular Therapy for Knee Osteoarthritis and Cartilage Defects

Summary and Comment |
October 6, 2016

Intra-Articular Cellular Therapy for Knee Osteoarthritis and Cartilage Defects

  1. Allan S. Brett, MD

A systematic review reveals that the quality of evidence to support this intervention is poor.

  1. Allan S. Brett, MD

Search the Internet for “cell + therapy + knee” and you'll discover numerous physicians and clinics that offer intra-articular stem cell injections for knee arthritis and cartilage defects. Typically, cells are harvested from blood, bone marrow, or fat, and cells might be combined with platelet-rich plasma.

To examine the evidence supporting intra-articular cellular therapy, researchers conducted a systematic review. They found six studies that met their search criteria: four randomized trials without blinding, one prospective cohort study, and one case-control study (300 knees total; half received the intervention). Three studies involved patients with osteoarthritis, and three involved patients with “focal cartilage defects.” Because studies were so heterogeneous in methodologies, interventions, selection of controls, and endpoints, meta-analysis could not be performed. Both the intervention and control groups tended to improve, with modestly better outcomes in the intervention groups for some (but not all) measures. Overall study quality was poor.

Comment

Because of the limitations noted above, the authors were unable to draw any conclusions about the efficacy of cellular therapy for structural knee problems. Perhaps these treatments provide some benefit, but if so, we don't yet have high-quality supporting evidence. Intra-articular stem cell therapy typically is not covered by insurance; on websites of several clinics that offer this treatment, I found quotes for out-of-pocket costs ranging from US$3,000 to $8,000 for treating one joint.

Editor Disclosures at Time of Publication

  • Disclosures for Allan S. Brett, MD at time of publication Nothing to disclose

Citation(s):

Reader Comments (1)

MICHAEL PALAZZOLO Physician, Internal Medicine, MPMG

Material presented is too limited and too obscurely defined to be able to draw any conclusions from. The variety of cell sources and insufficient samples under investigation without a control make the study a "mish-mash" of relatively worthless data. Future effort in studies of this type need to focus on the utility of the cell source being used, the anticipated mechanism of action of the injected cells and their interaction with the native structures and the reasons why a particular outcome would be expected. A large sample size should be considered as well as a control group (lots of patients with osteoarthritis and cartilage defects in our population). Be more focused, the present study tells us a bunch of nothing, but thanks should go to the authors for at least trying to find a solution to the much suffering of our patients with this condition.
Best regards, Michael Palazzolo

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