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Articular cartilage regeneration with autologous peripheral blood stem cells versus hyaluronic acid: a randomized controlled trial

PURPOSE:The purpose of this study was to compare histologic and magnetic resonance imaging (MRI) evaluation of articular cartilage regeneration in patients with chondral lesions treated by arthroscopic subchondral drilling followed by postoperative intra-articular injections of hyaluronic acid (HA)...

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Main Authors: Saw, Khay Yong, Anz, Adam, Jee, Caroline Siew Yoke, Merican, Shahrin, Ng, Reza Ching Soong, Syed Waseem Ahmad, Sharifah Roohi, Ragavanaidu, Kunasegaran
Format: Article
Language:English
Published: Elsevier 2013
Online Access:http://psasir.upm.edu.my/id/eprint/29730/1/Articular%20cartilage%20regeneration%20with%20autologous%20peripheral%20blood%20stem%20cells%20versus%20hyaluronic%20acid.pdf
http://psasir.upm.edu.my/id/eprint/29730/
http://www.sciencedirect.com/science/article/pii/S0749806312018993?via%3Dihub#!
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spelling my.upm.eprints.297302017-10-27T02:47:42Z http://psasir.upm.edu.my/id/eprint/29730/ Articular cartilage regeneration with autologous peripheral blood stem cells versus hyaluronic acid: a randomized controlled trial Saw, Khay Yong Anz, Adam Jee, Caroline Siew Yoke Merican, Shahrin Ng, Reza Ching Soong Syed Waseem Ahmad, Sharifah Roohi Ragavanaidu, Kunasegaran PURPOSE:The purpose of this study was to compare histologic and magnetic resonance imaging (MRI) evaluation of articular cartilage regeneration in patients with chondral lesions treated by arthroscopic subchondral drilling followed by postoperative intra-articular injections of hyaluronic acid (HA) with and without peripheral blood stem cells (PBSC). METHODS:Fifty patients aged 18 to 50 years with International Cartilage Repair Society (ICRS) grade 3 and 4 lesions of the knee joint underwent arthroscopic subchondral drilling; 25 patients each were randomized to the control (HA) and the intervention (PBSC + HA) groups. Both groups received 5 weekly injections commencing 1 week after surgery. Three additional injections of either HA or PBSC + HA were given at weekly intervals 6 months after surgery. Subjective IKDC scores and MRI scans were obtained preoperatively and postoperatively at serial visits. We performed second-look arthroscopy and biopsy at 18 months on 16 patients in each group. We graded biopsy specimens using 14 components of the International Cartilage Repair Society Visual Assessment Scale II (ICRS II) and a total score was obtained. MRI scans at 18 months were assessed with a morphologic scoring system. RESULTS:The total ICRS II histologic scores for the control group averaged 957 and they averaged 1,066 for the intervention group (P = .022). On evaluation of the MRI morphologic scores, the control group averaged 8.5 and the intervention group averaged 9.9 (P = .013). The mean 24-month IKDC scores for the control and intervention groups were 71.1 and 74.8, respectively (P = .844). One patient was lost to follow-up. There were no notable adverse events. CONCLUSIONS:After arthroscopic subchondral drilling into grade 3 and 4 chondral lesions, postoperative intra-articular injections of autologous PBSC in combination with HA resulted in an improvement of the quality of articular cartilage repair over the same treatment without PBSC, as shown by histologic and MRI evaluation. LEVEL OF EVIDENCE:Level II, randomized controlled trial (RCT). Elsevier 2013-04 Article PeerReviewed application/pdf en http://psasir.upm.edu.my/id/eprint/29730/1/Articular%20cartilage%20regeneration%20with%20autologous%20peripheral%20blood%20stem%20cells%20versus%20hyaluronic%20acid.pdf Saw, Khay Yong and Anz, Adam and Jee, Caroline Siew Yoke and Merican, Shahrin and Ng, Reza Ching Soong and Syed Waseem Ahmad, Sharifah Roohi and Ragavanaidu, Kunasegaran (2013) Articular cartilage regeneration with autologous peripheral blood stem cells versus hyaluronic acid: a randomized controlled trial. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 29 (4). pp. 684-694. ISSN 0749-8063; ESSN: 1526-3231 http://www.sciencedirect.com/science/article/pii/S0749806312018993?via%3Dihub#! 10.1016/j.arthro.2012.12.008
institution Universiti Putra Malaysia
building UPM Library
collection Institutional Repository
continent Asia
country Malaysia
content_provider Universiti Putra Malaysia
content_source UPM Institutional Repository
url_provider http://psasir.upm.edu.my/
language English
description PURPOSE:The purpose of this study was to compare histologic and magnetic resonance imaging (MRI) evaluation of articular cartilage regeneration in patients with chondral lesions treated by arthroscopic subchondral drilling followed by postoperative intra-articular injections of hyaluronic acid (HA) with and without peripheral blood stem cells (PBSC). METHODS:Fifty patients aged 18 to 50 years with International Cartilage Repair Society (ICRS) grade 3 and 4 lesions of the knee joint underwent arthroscopic subchondral drilling; 25 patients each were randomized to the control (HA) and the intervention (PBSC + HA) groups. Both groups received 5 weekly injections commencing 1 week after surgery. Three additional injections of either HA or PBSC + HA were given at weekly intervals 6 months after surgery. Subjective IKDC scores and MRI scans were obtained preoperatively and postoperatively at serial visits. We performed second-look arthroscopy and biopsy at 18 months on 16 patients in each group. We graded biopsy specimens using 14 components of the International Cartilage Repair Society Visual Assessment Scale II (ICRS II) and a total score was obtained. MRI scans at 18 months were assessed with a morphologic scoring system. RESULTS:The total ICRS II histologic scores for the control group averaged 957 and they averaged 1,066 for the intervention group (P = .022). On evaluation of the MRI morphologic scores, the control group averaged 8.5 and the intervention group averaged 9.9 (P = .013). The mean 24-month IKDC scores for the control and intervention groups were 71.1 and 74.8, respectively (P = .844). One patient was lost to follow-up. There were no notable adverse events. CONCLUSIONS:After arthroscopic subchondral drilling into grade 3 and 4 chondral lesions, postoperative intra-articular injections of autologous PBSC in combination with HA resulted in an improvement of the quality of articular cartilage repair over the same treatment without PBSC, as shown by histologic and MRI evaluation. LEVEL OF EVIDENCE:Level II, randomized controlled trial (RCT).
format Article
author Saw, Khay Yong
Anz, Adam
Jee, Caroline Siew Yoke
Merican, Shahrin
Ng, Reza Ching Soong
Syed Waseem Ahmad, Sharifah Roohi
Ragavanaidu, Kunasegaran
spellingShingle Saw, Khay Yong
Anz, Adam
Jee, Caroline Siew Yoke
Merican, Shahrin
Ng, Reza Ching Soong
Syed Waseem Ahmad, Sharifah Roohi
Ragavanaidu, Kunasegaran
Articular cartilage regeneration with autologous peripheral blood stem cells versus hyaluronic acid: a randomized controlled trial
author_facet Saw, Khay Yong
Anz, Adam
Jee, Caroline Siew Yoke
Merican, Shahrin
Ng, Reza Ching Soong
Syed Waseem Ahmad, Sharifah Roohi
Ragavanaidu, Kunasegaran
author_sort Saw, Khay Yong
title Articular cartilage regeneration with autologous peripheral blood stem cells versus hyaluronic acid: a randomized controlled trial
title_short Articular cartilage regeneration with autologous peripheral blood stem cells versus hyaluronic acid: a randomized controlled trial
title_full Articular cartilage regeneration with autologous peripheral blood stem cells versus hyaluronic acid: a randomized controlled trial
title_fullStr Articular cartilage regeneration with autologous peripheral blood stem cells versus hyaluronic acid: a randomized controlled trial
title_full_unstemmed Articular cartilage regeneration with autologous peripheral blood stem cells versus hyaluronic acid: a randomized controlled trial
title_sort articular cartilage regeneration with autologous peripheral blood stem cells versus hyaluronic acid: a randomized controlled trial
publisher Elsevier
publishDate 2013
url http://psasir.upm.edu.my/id/eprint/29730/1/Articular%20cartilage%20regeneration%20with%20autologous%20peripheral%20blood%20stem%20cells%20versus%20hyaluronic%20acid.pdf
http://psasir.upm.edu.my/id/eprint/29730/
http://www.sciencedirect.com/science/article/pii/S0749806312018993?via%3Dihub#!
_version_ 1643829847792812032
score 13.211869

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