Meta-analysis of Viscosupplementation for Knee Osteoarthritis Reveals Little Benefit

In the study outlined below, handling alongside viscosupplementation (typically diverse forms of hyaluronic acid) was studied inward over 12,500 patients.  This is an injection therapy used inward patients alongside articulatio genus osteoarthritis.  It is commonly reserved for patients that neglect other forms of treatment.  Here is the determination of this study of studies:  "In patients alongside articulatio genus osteoarthritis, viscosupplementation is associated alongside a modest as well as clinically irrelevant create goodness as well as an increased run a jeopardy for serious adverse events."

Clearly, the information shows this handling does non render transformative value.  We withdraw ameliorate options for patients alongside mild to moderate articulatio genus osteoarthritis.  Biologic therapies such every bit platelet rich plasma and autologous stalk cells are evolving only nonetheless withdraw significantly ameliorate studies to endure used for articulatio genus osteoarthritis widely.  

It is oft NOT discussed only patients alongside articulatio genus osteoarthritis tin hand the axe oft create goodness from weight reduction as well as leg strengthening via an practice wheel program.  Perhaps nosotros should focus on these patient driven solutions first.

AM

Total Tendon

Viscosupplementation for Osteoarthritis of the Knee: A Systematic Review as well as Meta-analysis 

Anne W.S. Rutjes, PhD; Peter Jüni, MD; Bruno R. da Costa, MSc; Sven Trelle, MD; Eveline Nüesch, PhD; as well as Stephan Reichenbach, MD, MScBackground: Viscosupplementation, the intra-articular injection of hyaluronic acid, is widely used for symptomatic articulatio genus osteoarthritis.

Purpose: To assess the benefits as well as risks of viscosupplementation for adults alongside symptomatic articulatio genus osteoarthritis.

Data Sources: MEDLINE (1966 to Jan 2012), EMBASE (1980 to Jan 2012), the Cochrane Central Register of Controlled Trials (1970 to Jan 2012), as well as other sources.

Study Selection: Randomized trials inward whatsoever linguistic communication that compared viscosupplementation alongside sham or nonintervention command inward adults alongside articulatio genus osteoarthritis.

Data Extraction: Primary outcomes were hurting intensity as well as flare-ups. Secondary outcomes included share as well as serious adverse events. Reviewers used duplicate abstractions, assessed study quality, pooled information using a random-effects model, examined funnel plots, as well as explored heterogeneity using meta-regression.

Data Synthesis: Eighty-nine trials involving 12 667 adults met inclusion criteria. Sixty-eight had a sham control, forty had a follow-up duration greater than iii months, as well as 22 used cross-linked forms of hyaluronic acid. Overall, 71 trials (9617 patients) showed that viscosupplementation moderately reduced hurting (effect size, −0.37 [95% CI, −0.46 to −0.28]). There was of import between-trial heterogeneity as well as an asymmetrical funnel plot: Trial size, blinded outcome assessment, as well as publication condition were associated alongside final result size. Five unpublished trials (1149 patients) showed an final result size of −0.03 (CI, −0.14 to 0.09). Eighteen large trials alongside blinded outcome assessment (5094 patients) showed a clinically irrelevant final result size of −0.11 (CI, −0.18 to −0.04). Six trials (811 patients) showed that viscosupplementation increased, although non statistically significantly, the run a jeopardy for flare-ups (relative risk, 1.51 [CI, 0.84 to 2.72]). Fourteen trials (3667 patients) showed that viscosupplementation increased the run a jeopardy for serious adverse events (relative risk, 1.41 [CI, 1.02 to 1.97]).

Limitations: Trial lineament was to a greater extent than oft than non low. Safety information were oft non reported.

Conclusion: In patients alongside articulatio genus osteoarthritis, viscosupplementation is associated alongside a modest as well as clinically irrelevant create goodness as well as an increased run a jeopardy for serious adverse events.

Link to Abstract

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Can Stem Cells Cure Knee Arthritis?

Can Stem Cells Cure Knee Arthritis?

Unfortunately, the response to that query is non known today.  It is clear, however, that many new regenerative therapies are emerging to assist the tens of millions of patients worldwide that are suffering from knee articulation arthritis.

First, nosotros must explore what type of stalk cells could last helpful inwards the handling of arthritis.  Stem cells of diverse types tin last obtained from your blood (peripheral derived stalk cells), os marrow (mesenchymal stalk cells), fatty (adipose derived stalk cells), together with fifty-fifty from umbilical cord blood.  Studies today are exploring diverse ways to extract, purify together with concentrate many types of stalk cells.  The cells tin together with thus last injected equally a time out into your knee, used equally business office of surgical physical care for or fifty-fifty injected afterwards an operation.

Microfracture of Damaged Knee Cartilage

One recent written report (Vangsness et al 2014) showed how an injection of mesenchymal stalk cells could Pb to to a greater extent than meniscus tissue afterwards a knee articulation arthroscopy.  24% of the treated grouping were establish to cause got at to the lowest degree 15% increased meniscal volume.  This is a pocket-size sum inwards solely a a quarter of the patients but it does correspond a start.  Another written report published final twelvemonth (Saw et al 2013), injected peripheral derived stalk cells afterwards a microfracture physical care for together with noted improvement inwards the cartilage quality.  Other approaches (Pak et al 2014) purpose adipose derived stalk cells from liposuction inwards combination amongst platelet-rich plasma to care for meniscus tears.  Finally, a review (Anderson et al 2013) of potential stalk jail cellular telephone therapies for knee articulation cartilage outlines many potential together with emerging options.

Also, a multifariousness of procedures equally good purpose non-stem cells to care for arthritis of the knee.  One of the oldest is called autologous chondrocyte implantation.  This is where a biopsy of your ain cartilage is taken together with and thus grown inwards a lab.  The expanded cells together with and thus reimplanted into an arthritic lesion of the knee.  Another physical care for merely penetrates the os nether the defective cartilage.  This leads to leakage of to a greater extent than or less of the os marrow along amongst your ain the stalk cells inside the marrow into the defect.  This is called microfracture.  Yet to a greater extent than or less other physical care for uses juvenile cartilage that is minced together with and thus glued into a arthritic zone of the knee.

It is clear that at that topographic point are many competing approaches to the purpose of cells together with stalk cells to care for knee articulation arthritis.  None cause got "cured" the problem.   There is, however, an earnest worldwide enquiry essay that volition attain clinically meaningful options for clinicians together with patients.

Millions worldwide are waiting for that day.

AM
TotalTendon

References
Anderson et al 2013
Saw et al 2013
Vangsness et al 2014
Pak et al 2014

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Fat Stem Cells attention Knee Arthritis

Knee Arthritis is a real hard job to solve.  Millions of patients endure daily from this progressive affliction state.  A diverseness of new biologic therapies are inwards development.

Stem cells tin come upward from a diverseness of sources including your ain fat.  These cells are known every bit adipose derived stalk cells.  A recent written report from Korea suggests at that topographic point is value using this type of prison theatre cellphone for human knee arthritis.  Researchers gave patients escalating dose of the cells together with flora the high dose resulted inwards improved hurting together with constituent scores.  They every bit good flora the cartilage defect defect size decreased field the book of cartilage inwards the human knee increased.

Fat Derived Stem Cells

This information is encouraging together with volition bespeak to hold upward repeated prior to wide clinical use.  (See abstract below)

For patients amongst this problem, the horizon is vivid amongst many potential options similar stalk cells from your ain fat.

AM
TotalTendon

Stem Cells. 2014 May;32(5):1254-66. doi: 10.1002/stem.1634.

Intra-articular injection of mesenchymal stem cells for the handling of osteoarthritis of the knee: a proof-of-concept clinical trial.

Jo CH1, Lee YG, Shin WH, Kim H, Chai JW, Jeong EC, Kim JE, Shim H, Shin JS, Shin IS, Ra JC, Oh S, Yoon KS.

Author information

Abstract

Mesenchymal stem cells (MSCs) are known to convey a potential for articular cartilage regeneration. However, virtually studies focused on focal cartilage defect through surgical implantation. For the handling of generalized cartilage loss inwards osteoarthritis, an alternative delivery strategy would hold upward to a greater extent than appropriate. The job of this written report was to assess the security together with efficacy of intra-articular injection of autologous adipose tissue derived MSCs (AD-MSCs) for knee osteoarthritis. We enrolled xviii patients amongst osteoarthritis of the knee and injected AD MSCs into the knee. The stage I written report consists of iii dose-escalation cohorts; the low-dose (1.0 × 10(7)cells), mid-dose (5.0 × 10(7)), together with high-dose (1.0 × 10(8)) grouping amongst iii patients each. The stage II included nine patients receiving the high-dose. The top dog outcomes were the security together with the Western Ontario together with McMaster Universities Osteoarthritis index (WOMAC) at vi months. Secondary outcomes included clinical, radiological, arthroscopic, together with histological evaluations. There was no treatment-related adverse event. The WOMAC marking improved at vi months afterward injection inwards the high-dose group. The size of cartilage defect decreased field the book of cartilage increased inwards the medial femoral together with tibial condyles of the high-dose group. Arthroscopy showed that the size of cartilage defect decreased inwards the medial femoral together with medial tibial condyles of the high-dose group. Histology demonstrated thick, hyaline-like cartilage regeneration. These results showed that intra-articular injection of 1.0 × 10(8) AD MSCs into the osteoarthritic knee improved constituent together with hurting of the knee joint without causing adverse events, together with reduced cartilage defects past times regeneration of hyaline-like articular cartilage.

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Microfracture Surgery Jadaveon Clowney

The Houston Texans' Jadeveon Clowney late underwent "microfracture" surgical physical care for on his ailing correct knee.  (See ESPN report)

The study suggests the talented Mr. Clowney volition hold upwards out for ix months or more.  Just what is microfracture surgical physical care for too why does it accept equally long to recovery equally it does for a infant to born?

Microfracture Surgery

Let's starting fourth dimension amongst the basics.  There are 2 types of cartilage inwards the knee.  The surface cartilage which covers the bone.  This is known equally articular cartilage too tin flame hold upwards idea of a type of cap or roofing of the terminate of the bone.  This cartilage is introduce inwards whatever joint.  In the knee, in that place is around other type of cartilage, the meniscus cartilage.  There are 2 menisci inwards the knee--medial (inside) too lateral (outside).  When the surface "articular" cartilage is damaged, the genu tin flame move quite painful peculiarly amongst loading too twisting.  Think rushing a passer for example.  Similar symptoms tin flame come about when the meniscus is torn.  It is ofttimes hard to distinguish betwixt the 2 inwards price of which i is the hurting generator.

Microfracture surgical physical care for is an endeavour to exercise a tire piece over a cartilage defect past times poking a hole inwards the terminate of the os too creating an access channel to the os marrow.  The os marrow too thence leaks out via the holes that are created too forms a clot which over fourth dimension tin flame help comprehend the defect.  It takes time, many months, for this surgical physical care for to move because the "patch" needs to mature.  This technique is useful for pocket-sized defects inwards the cartilage simply hasn't proven to hold upwards bully for larger defects.  We exercise non know the size of Mr. Clowney's genu cartilage injury.

Recent evidence suggests that the add-on of platelet-rich plasma tin flame lift microfracture surgical physical care for results.  This has been shown inwards basic science, preclinical too instantly clinical studies.

This type of surgical physical care for at such a immature historic current is clearly non a expert sign.  In the long run, he may require farther intervention.  Please read the postal service below for farther data close why nosotros demand to accelerate our regenerative medicine efforts.  Mr. Clowney is i of tens of millions of people worldwide amongst symptomatic cartilage damage.  We demand to maximize outcomes of today's surgical techniques too prepare novel procedures to help continue our athletes too patients inwards the game.

AM

TotalTendon



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Using a 3D Printer to Make a Knee Meniscus

Meniscus cartilage is the cushioning tissue betwixt the femur too tibia bones of the knee.  Millions of Americans each twelvemonth tear this cartilage.  Loss of the meniscus tissue tin atomic number 82 to arthritis.

In this novel approach, researchers inwards New York are using a 3D Printer to exercise a novel meniscus.  They bring studied inwards sheep too thence far amongst success.  In the future, it may live possible to purpose an MRI scan amongst a meniscus tear to assistance programme a 3D printer to brand you lot a novel meniscus.  Treatment inwards human patients is non even too thence available simply this is quite an intriguing possibility for the future.

Reference
TISSUE ENGINEERING

Protein-releasing polymeric scaffolds cause fibrochondrocytic differentiation of endogenous cells for articulatio genus meniscus regeneration inwards sheep

1. Chang H. Lee1, 
2. Scott A. Rodeo2, 
3. Lisa Ann Fortier3, 
4. Chuanyong Lu1, 
5. Cevat Erisken1 and 
6. Jeremy J. Mao1,*

Read More

Read the scientific abstract

AM
TotalTendon
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