Outcome of Intra-articular Injection of Total Stromal Cells and Platelet-Rich Plasma in Primary Knee Osteoarthritis: A Randomized Clinical Trial

Moshiur R Khasru; Md Abu B Siddiq; Talukder Agm Zakaria N Jubery; Tangila Marzen; Ashraful Hoque; Akm Zahir Ahmed; Masuda Begum; Fazle R Chowdhury; Abul Khair M Salek; Md Moniruzzaman Khan

doi:10.7759/cureus.34595

Outcome of Intra-articular Injection of Total Stromal Cells and Platelet-Rich Plasma in Primary Knee Osteoarthritis: A Randomized Clinical Trial

Cureus. 2023 Feb 3;15(2):e34595. doi: 10.7759/cureus.34595. eCollection 2023 Feb.

Authors

Affiliations

¹ Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University, Dhaka, BGD.
² Physical Medicine and Rehabilitation, Brahmanbaria Medical College, Brahmanbaria, BGD.
³ Rheumatology, University of South Wales, Pontypridd, Wales, GBR.
⁴ Burn and Plastic Surgery, Dhaka Medical College Hospital, Dhaka, BGD.
⁵ Anatomy, Shaheed Suhrawardy Medical College Hospital, Dhaka, BGD.
⁶ Blood Transfusion, Sheikh Hasina National Institute of Burn & Plastic Surgery, Dhaka, BGD.
⁷ Musculoskeletal Sonography, Module General Hospital, Dhaka, BGD.
⁸ Hematology, Bangabandhu Sheikh Mujib Medical University, Dhaka, BGD.
⁹ Internal Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, BGD.

Abstract

Introduction: Mesenchymal stem cell (MSC) therapy appeared promising in knee osteoarthritis (OA). We examined if a single intra-articular (IA) autologous total stromal cells (TSC) and platelet-rich plasma (PRP) injection improved knee pain, physical function, and articular cartilage thickness in knee OA.

Methods: The study was performed in the physical medicine and rehabilitation department of Bangabandhu Shaikh Mujib Medical University, Dhaka, Bangladesh. Knee OA was diagnosed according to the American College of Rheumatology criteria and randomly assigned to treatment (received TSC and PRP) and control groups. Kallgreen-Lawrance (KL) scoring system was used to grade primary knee OA. The Visual Analogue Scale (VAS, 0-10 cm) for pain, WOMAC (Western Ontario and McMaster Universities Arthritis Index) for physical function, and medial femoral condylar cartilage (MFC) thickness (millimeters) under ultrasonogram (US) were documented and compared between groups before and after treatment. Statistical Package analyzed data for Social Scientists (SPSS 22.0; IBM Corp, Armonk, NY) was used for data analysis. Pre- and post-intervention outcomes were measured using the Wilcoxon-sign test, whereas Mann-Whitney U-test calculated the difference between groups; a p-value <0.05 was considered statistically significant. Result: In the treatment group, 15 received IA-TSC and PRP preparation, and in the control group, 15 patients received no injection, but quadricep muscle-strengthening exercise. There was no significant difference between groups regarding VAS for pain, WOMAC physical function, and cartilage thickness before starting the treatment and two weeks after intervention. VAS for pain and WOMAC physical function scores improved profoundly in the treatment group after 12 and 24 weeks of intervention; the pain and physical function scores difference between groups was also significant. However, significant mean femoral cartilage thickness was not changed until the end of 24 weeks (U=175.00, p=0.009 two-tailed and U= 130.00, p=0.016 two-tailed, respectively, for right and left knee).

Conclusion: Single TSC and PRP injection reduces knee pain and improves physical function and cartilage thickness in knee OA. While pain and physical function improvement happen earlier, cartilage thickness change takes more time.

Keywords: knee osteoarthritis; mesenchymal stem cell; osteoarthritis; single intra-articular injection; total-stromal-cells (tost).