Autologous bone marrow derived mesenchymal stem cells as a novel therapy for articular cartilage defects in osteoarthritis knee
Osteoarthritis of the knee is a leading cause of morbidity. No effective therapy is available today that alters the pathobiology course of osteoarthritis. Aim was to study the safety and efficacy of mesenchymal stem cells (MSCs) in knee osteoarthritis. 12 patients with Ahlbacks’ grade one or two bilateral osteoarthritis knees were enrolled. 8 to10 ml of bone marrow was aspirated under strict aseptic precautions from iliac spine. After stem cell culture and expansion for four to six weeks, cells which were found adherent to the culturing flask were removed with 0.05% trypsin-EDTA solution and characterized using antibodies. Cells positive for CD 90 and CD 105 and negative for CD 45 and CD 34 were the mesenchymal stem cells. These were then sub-cultured. MSC suspension in 10xPBS was injected directly into 24 knees by lateral approach. Clinical outcome was evaluated by modified VAS, WOMAC and KOOS scores. Quantitative articular cartilage thickness analysis was done by MRI performed pre-procedure and post-procedure at final follow up. MRI measurement was evaluated by modified WORMS score. Statistically significant improvement in VAS, total WOMAC and total KOOS score was observed from pre injection to follow ups at six weeks, six months and final follow up of 26.7 months (mean). Modified WORMS score showed a statistically significant decrease of 1.49%. Intra-articular injection of autologous bone marrow derived culture-expanded MSCs can be considered a potential treatment of early osteoarthritis knee which relieves pain, stiffness, improves physical functions, and improves the articular cartilage integrity.