Abstract: Background: Various modalities of treatment are defined for the treatment of osteoarthritis of knee. The spectrum of treatment ranges from pharmacological management to surgical management in form of total knee replacement. Another attractive modality of treatment is the use of adult mesenchymal progenitor cells in the management of osteoarthritis. We studied the effect of adult mesenchymal progenitor cells on the ongoing degenerative process of knee osteoarthritis as well as its role in clinical and functional outcome.
Materials and Methods: 70 patients presenting to our outpatient department between July 2018 to June 2020 and satisfying inclusion and exclusion criteria were included in the study. This prospective study was approved by the local ethical committee. Follow-up was at 6th week and subsequently at 3, 6, and 12 months post procedure. Clinical outcome was measured using Visual Analogue Scale (Pain Grading); Cartilage healing according to MRI (Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) Scale) before the procedure and 12 months post procedure(first dose); Diagnostic arthroscopy with biopsy and staining of affected area before the procedure and 12 months post procedure (first dose) whereas functional outcome was measured using International Knee Documentation Committee (IKDC) System Score.
Results: During analysis we had 60 patients under study out of which 24 patients had Grade II knee osteoarthritis, 20 patients had Grade III knee osteoarthritis and 16 patients had Grade IV knee osteoarthritis. Significant improvement in functional outcome in terms of IKDC Score was observed in patients having Grade II knee osteoarthritis followed by patients with Grade III knee osteoarthritis with least significant improvement in patients with Grade IV osteoarthritis. A similar significant improvement in clinical outcome in terms of VAS score, MOCART scale score and diagnostic arthroscopy was observed in patients having Grade II knee osteoarthritis followed by patients with Grade III knee osteoarthritis (p<0.0001). In patients with Grade IV osteoarthritis no significant improvement in terms of MOCART Scale Score (p=0.06) and diagnostic arthroscopy findings although some improvement could be appreciated in VAS score.
Conclusion: The intra-articular mesenchymal progenitor cell injection can revert the degenerative process by chondrogenesis up to varying degree in different grade of osteoarthritis, including the areas where subchondral bone is exposed. The degree of regeneration of articular cartilage was in varying degrees in different cases. Any definitive parameter to predict pre-operatively for degree of regeneration of articular cartilage by intra-articular mesenchymal progenitor cell therapy could not be established.
