Problem: Osteoarthritis (OA) is a debilitating, degenerative disease characterized by progressive erosion of articular cartilage and is a major cause of disability and chronic pain. Articular cartilage, due to its structural characteristics, has shown limited regenerative capacity after injury.
Evidence of background: The stem cells mesenchymal autologous have been used to treat orthopaedic conditions degenerative during more than two decades. The intra-articular injection of bone marrow mononuclear cells (BMMNCs) appears to be safe for the treatment of osteoarthritis of the knee (knee OA). In addition, the concentrated bone marrow aspirate (BMAC) is one of the best options in EE. UU. The growth factors derived from the bone marrow (BMPC) seem to be potential for the treatment of cartilage injury.Hypothesis:intra-articular application of BMMNCs and BMPC in a single dose and single is a safe and effective option for the treatment of osteoarthritis of the knee.
Research: This is a descriptive study of a prospective level I, between January 2018 and December 2019. 69 patients, range: 45-89 years, with osteoarthritis of the knee, Kellgren Lawrence (KL) grade III and IV received an intraarticular injection of BMMNCs and BMPC in the same syringe (3 ml) at a mean dose of 1.26×10 (9) / ml of mononuclear cells and 655.000 / ml of platelets. (Table 1) The main symptoms of osteoarthritis of the knee and the changes in the structure of the tissue were evaluated after 12 months by comparing the score on the visual analog (VAS) and the score of knee injury and outcome, orthopedic (KOOS) at different times.
Observations and results: The score KOOS was obtained at different times after the first visit: up to 3 months after for 25 patients, 3 to 6 months for 12 patients and 12 months after for 7 patients. The categories "6 to 9 months" and "more than 9 months" were considered separately, however, the small number of observations in each one (3 and 4, respectively) led him to join them in the category of "12 months". Table 2 and Graph 1 show the medians of the scores for each of the times listed. The average score of KOOS in the time of "0 to 3 months" showed a statistically significant increase with respect to the initial time (p <0.001) and a reduction in the moment, "3 to 6 months" with respect to the previous time that was not statistically significant (p = 0.313). Finally, the median of the KOOS returns to file a reduction at the last moment, "12 months", with respect to "3 to 6 months" of similar magnitude to the previous reduction. The small number of patients in this last moment does not allow the comparison of formal is carried out by a statistical test. The initial value of VAS ranged between 4 and 10 with a median equal to 8.5 in patients. The score KOOS is calculated from sub-scales namely: symptoms, stiffness, pain, function in daily activities, operation in sports and recreational activities and quality of life. Table 3 and figure 2 present the average of the Score for each combination of the subscales and the times of measurement.
In each subscale, the comparison of medians was performed at the initial time versus the time "0 to 3 months", and between the moments "0 to 3 months" and "3 to 6 months." In all cases, the increase in the score from the initial time up to the time of "0 to 3 months" was significant (p <0.001 for all subscales). There were No significant differences between the medians of the scores in the moments of "0 to 3 months" and "3 to 6 months" (symptoms: p = 1.000; stiffness: p = 0.423; pain: p = 0.313; functioning in daily activities : p = 0.313; working in sports and recreation activities: p = 0.125; quality of life: p = 1,000). Could not make a comparison, a formal medium of times "3 to 6 months" and "12 months" due to the small number of observations collected in this last moment.
Conclusion: The intra-articular injection of a single dose of BMMNC and BMPC for the treatment of knee OA is a secure protocol and may improve the patient's quality of life.
