Osteoarthritis (OA) is a degenerative disease that, without intervention, will progress with age and result in the loss of articular cartilage. The loss of articular cartilage frequently is associated with other structural defects, such as osteophyte formation or subchondral sclerosis. This disease is most commonly seen affecting the knee joint, especially in patients aged 45 years or older.
Historically, the go to treatment for severe knee OA has been surgery. While there are alternative treatments available, such as physical therapy, NSAIDs, corticosteroid injections or hyaluronic acid injections, none of these options boast long term-benefits and have demonstrated no regenerative potential. Use of platelet-rich plasma (PRP) has been shown to have a longer lasting therapeutic benefit than other options, but the duration of benefit generally is about a year or a year and a half in most patients.
In Dr. Mitchell Sheinkop’s recently published paper[TS1] , entitled “Two-Year Outcome in the Treatment of Knee Osteoarthritis with a Combination of Intraarticular and Intraosseous Autologous Bone Marrow Concentrate,” he provides clinical outcomes out to two-years in treating knee OA with autologous bone marrow concentrate (BMC) delivered through both intraarticular (IA) and intraosseous (IO) injections during the same treatment. In this study, which was sponsored by Celling Biosciences, a total of 20 patients (22 knees) with knee OA classified as either a level II or III on the Kellgren-Lawrence (KL) grade (average KL score was 2.9 at baseline) were treated with BMC obtained with Celling Bioscience’s ART BMC Plus device. The BMC was divided between an IO injection (80% of the BMC volume) and an IA injection (20% of the volume). The IA treatment was augmented with autologous concentrated PPP obtained with the device’s on-board filter. Prior to treatment, the patients were evaluated for the following clinical endpoints to provide a baseline: Knee Society Score Knee (KSS-Knee), Knee Society Score Function (KSS-Function), Lower Extremity Function Scale (LEFS), Visual Analog Scale (VAS), and Range of Motion (ROM). The patients were then assessed for these endpoints for two years post-treatment.
A total of 16 patients (18 knees) reached the two-year milestone, while three patients underwent a total knee replacement and one patient underwent a uni-compartmental knee arthroplasty due to acute trauma while weightlifting. ROM and the participant-reported outcomes (VAS, KSS-Knee, KSS-Function, and LEFS), were evaluated at each visit and showed a statistically meaningful improvement at the two-year mark in comparison to baseline. KL grades at two-years were compared to baseline and showed that five knees worsened a grade, three knees improved a grade, while the majority of knees remained the same. Dr. Sheinkop indicated that since knee OA is a progressive degenerative disease, the fact that the majority of the knees did not worsen, with some even improving, points to the possibility of a stabilizing effect of the BMC treatment.
As Dr. Sheinkop stated in the article’s abstract:
“Safety was demonstrated for the bone marrow concentrate-combined treatment via intraosseous and intraarticular routes for treating Kellgren-Lawrence II-III knee osteoarthritis during the two-year study period.” The abstract also stated that “These results point to a potential durable benefit in pain mitigation and improved quality of life for patients with knee osteoarthritis who receive bone marrow concentrate via the intraosseous and intraarticular routes for treating knee osteoarthritis.”
.png){kind=small}