Stem cell injections for osteoarthritis of the knee.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: Renea Johnston, Rachelle Buchbinder and Steve McDonald are recipients of a National Health and Medical Research Council Cochrane Collaboration Round 7 Funding Program Grant, which supports the activities of Cochrane Musculoskeletal ‐ Australia and Cochrane Australia, but the funders did not participate in the conduct of this review. Tanay Bapna is a medical student at Monash University. Rachelle Buchbinder is a Rheumatologist (adult) and the Co‐ordinating Editor of Cochrane Musculoskeletal. She was not involved in the editorial process for this review. RB declares royalties for a book chapter on plantar fasciitis. Mark Campbell is a health professional and conducts clinical work at Bruyere Continuing Care, Ottawa, Canada. His clinical activities include treating patients with osteoarthritis; however, stem cell use for osteoarthritis has never been a part of his practice. Sheila Cyril is the Assistant Managing Editor of Cochrane Musculoskeletal. She was not involved in the editorial process for this review. Renea Johnston is the Managing Editor of Cochrane Musculoskeletal. She was not involved in the editorial process for this review. Steve McDonald is Co‐Director of Cochrane Australia and an Information Specialist with the Cochrane Central Editorial Service. He was not involved in the editorial process for this review. Samuel Whittle is a Senior Consultant Rheumatologist at The Queen Elizabeth Hospital, Vice President of the Australian Rheumatology Association and a Cochrane Musculoskeletal Editor. He was not involved in the editorial process for this review. Daniel Worthley declares a patent for osteochondroreticular stem cells for bone and cartilage regeneration (US‐20170335283‐A1), which is held by his previous institution. Jason Zhang declares that he has no conflicts of interest. 11. Knee Surg Sports Traumatol Arthrosc. 2024 Nov;32(11):2938-2949. doi: 10.1002/ksa.12320. Epub 2024 Jul 4. Platelet-rich plasma injections for the management of knee osteoarthritis: The ESSKA-ICRS consensus. Recommendations using the RAND/UCLA appropriateness method for different clinical scenarios. Kon E(1)(2), de Girolamo L(3), Laver L(4)(5)(6), Andriolo L(7), Andia I(8), Bastos R(9)(10), Beaufils P(11), Biant L(12)(13), Bøe B(14), Boffa A(7), Cugat R(15)(16)(17), Di Martino A(7), Erggelet C(18), Iosifidis M(19)(20), Kocaoglu B(21), Magalon J(22)(23)(24), Marinescu R(25), Nehrer S(26)(27), Niemeyer P(28), Ostojić M(29), Piontek T(30), Sánchez M(31)(32), Sas K(33)(34), Skarpas G(35)(36)(37), Tischer T(38), Vonk L(39)(40), Filardo G(41)(42)(43). Author information: (1)IRCCS Humanitas Research Center, Rozzano, Milan, Italy. (2)Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy. (3)IRCCS Ospedale Galeazzi Sant'Ambrogio, Orthopaedic Biotechnology Laboratory, Milano, Italy. (4)Department of Orthopaedics, Hillel Yaffe Medical Center (HYMC), Hadera, Israel. (5)Rappaport Faculty of Medicine, Technion University Hospital, Israel Institute of Technology, Haifa, Israel. (6)Arthrosport Clinic, Tel-Aviv, Israel. (7)Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy. (8)Regenerative Therapies, Biobizkaia Health Research Institute, Barakaldo, Spain. (9)Clinica Espregueira - Fifa Medical Centre of Excellence, Porto, Portugal; Hospital Lusíadas Santa Maria da Feira, Santa Maria da Feira, Portugal. (10)Fluminense Federal University, Niterói, Rio de Janeiro, Brazil. (11)ESSKA Consensus Projects, Versailles, France. (12)Division of Cell Matrix Biology & Regenerative Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK. (13)Department of Orthopaedics, Trafford General Hospital, Manchester University NHS Foundation Trust, Manchester, UK. (14)Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway. (15)Mutualidad de Futbolistas Españoles - Delegación Catalana, Barcelona, Spain. (16)Instituto Cugat, Hospital Quironsalud Barcelona, Barcelona, Spain. (17)Fundación García Cugat, Barcelona, Spain. (18)Alphaclinic Zurich, University of Freiburg Medical Center, Zurich, Switzerland. (19)3rd Orthopaedic Department, Interbalkan Medical Center, Thessaloniki, Greece. (20)OrthoBiology Surgery Center, Thessaloniki, Greece. (21)Department of Orthopedic Surgery, Faculty of Medicine, Acibadem University, Istanbul, Turkey. (22)Cell Therapy Laboratory, Hôpital De La Conception, AP-HM, Marseille, France. (23)INSERM, INRA, C2VN, Aix Marseille Univ, Marseille, France. (24)Remedex Network, Marseille, France. (25)Department of Orthopedics, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania. (26)Center for Regenerative Medicine, Department for Health Sciences, Medicine and Research, University for Continuing Education Krems, Krems, Austria. (27)Department of Orthopaedics and Traumatology, University Hospital Krems, Krems, Austria. (28)OCM - Hospital for orthopedic Surgery Munich, Munich, Germany. (29)Department of Orthopaedics, University Hospital Mostar, Mostar, Bosnia and Herzegovina; Osteon Orthopedics and Sports Medicine Clinic, Mostar, Bosnia and Herzegovina. (30)Rehasport Clinic, Department of Spine Disorders and Pediatric Orthopedics, University of Medical Sciences Poznan, Poznan, Poland. (31)Arthroscopic Surgery Unit, Hospital Vithas Vitoria, Vitoria-Gasteiz, Spain. (32)Advanced Biological Therapy Unit, Hospital Vithas Vitoria, Vitoria-Gasteiz, Spain. (33)Orthopaedic Center (ORTHOCA), Antwerp, Belgium. (34)La clinique du Sport, Hôpital Erasme, Bruxelles, Belgium. (35)Heal Academy-HHG, University of Nicosia, Nicosia, Cyprus. (36)3rd Orthopaedic Department for Sports Injuries & Regenerative Medicine, "MITERA" General Hospital-HHG, Attiki, Greece. (37)Hellenic Open University, Patra, Greece. (38)Department of Orthopaedic Surgery, University of Rostock, Rostock, Germany. (39)Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands. (40)Xintela AB, Lund, Sweden. (41)Applied and Translational Research (ATR) Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy. (42)Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland. (43)Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland. PURPOSE: The aim of this consensus was to develop evidence- and expert-based patient-focused recommendations on the appropriateness of intra-articular platelet-rich plasma (PRP) injections in different clinical scenarios of patients with knee osteoarthritis (OA). METHODS: The RAND/UCLA Appropriateness Method was used by the European Society of Sports Traumatology, Knee Surgery, and Arthroscopy (ESSKA), as well as the International Cartilage Regeneration and Joint Preservation Society (ICRS) to reach a consensus and produce recommendations for specific patient categories combining best available scientific evidence with the collective judgement of a panel of experts. RESULTS: Scenarios were defined based on first treatment vs first injective treatment vs second injective treatment, age (80), tibiofemoral vs patellofemoral involvement, OA level (Kellgren-Lawrence/KL 0-I/II-III/IV), and joint effusion (dry knee, minor-mild or major effusion). Out of 216 scenarios, in 84 (38.9%) the indication was considered appropriate, in 9 (4.2%) inappropriate and in 123 (56.9%) uncertain. The parameters associated with the highest consensus were PRP use after failed injective treatments (62.5%), followed by PRP after failed conservative treatments and KL 0-III scenarios (58.3%), while the highest uncertainty was found for PRP use as first treatment and KL IV OA (91.7% and 87.5% of uncertain scenarios, respectively). CONCLUSION: This ESSKA-ICRS consensus established recommendations on the appropriateness or inappropriateness of PRP injections for the treatment of knee OA, providing a useful reference for clinical practice. PRP injections are considered appropriate in patients aged ≤80 years with knee KL 0-III OA grade after failed conservative non-injective or injective treatments, while they are not considered appropriate as first treatment nor in KL IV OA grade. LEVEL OF EVIDENCE: Level I. © 2024 The Author(s). Knee Surgery, Sports Traumatology, Arthroscopy published by John Wiley & Sons Ltd on behalf of European Society of Sports Traumatology, Knee Surgery and Arthroscopy. DOI: 10.1002/ksa.12320