PMID- 35019764
OWN - NLM
STAT- MEDLINE
DCOM- 20230302
LR  - 20230303
IS  - 1552-3365 (Electronic)
IS  - 0363-5465 (Linking)
VI  - 51
IP  - 3
DP  - 2023 Mar
TI  - Intra-articular Injection of Autologous Adipose-Derived Stem Cells or Stromal 
      Vascular Fractions: Are They Effective for Patients With Knee Osteoarthritis? A 
      Systematic Review With Meta-analysis of Randomized Controlled Trials.
PG  - 837-848
LID - 10.1177/03635465211053893 [doi]
AB  - BACKGROUND: Intra-articular injection of adipose-derived stem cells, which are 
      divided into adipose-derived mesenchymal stem cells (ASCs) and adipose-derived 
      stromal vascular fractions (ADSVFs), has been reported to be a viable treatment 
      modality for knee osteoarthritis (OA); however, its efficacy remains limited. 
      PURPOSE: This study aimed to provide comprehensive information about the efficacy 
      and safety of intra-articular injections of autologous ASCs and ADSVFs without 
      adjuvant treatment in patients with knee OA. STUDY DESIGN: Meta-analysis; Level 
      of evidence, 1. METHODS: A systematic search of the MEDLINE, Embase, Web of 
      Science, and Cochrane Library databases was performed to identify randomized 
      controlled trials (RCTs) that evaluated the efficacy and safety of 
      intra-articular injections of autologous ASCs or ADSVFs without adjuvant 
      treatments compared with placebo or hyaluronic acid in patients with knee OA. 
      Clinically, the 100-mm visual analog scale for pain relief and the Western 
      Ontario and McMaster Universities Osteoarthritis Index for functional improvement 
      were implemented. Radiologically, cartilage status was assessed using magnetic 
      resonance imaging (MRI). Procedure-related knee pain, swelling, and adverse 
      events (AEs) were evaluated for safety. Additionally, we performed subgroup 
      analyses comparing ASCs versus ADSVFs. Methodological quality was assessed using 
      the modified Coleman Methodology Score (mCMS). RESULTS: A total of 5 RCTs were 
      included in this study. Based on the meta-analysis, ASCs or ADSVFs showed 
      significantly better pain relief at 6 months (Z = 7.62; P < .0001) and 12 months 
      (Z = 7.21; P < .0001) and functional improvement at 6 months (Z = 4.13; P < 
      .0001) and 12 months (Z = 3.79; P = .0002), without a difference in 
      procedure-related knee pain or swelling compared with controls. Although a 
      meta-analysis with regard to cartilage improvements was not performed owing to 
      heterogeneous MRI assessment, 3 studies reported significantly improved cartilage 
      status after the injection. No serious AEs associated with ASCs or ADSVFs were 
      reported. Subgroup analyses showed similar efficacy between ASC and ADSVF 
      treatments. The median mCMS was 70 (range, 55-75). CONCLUSION: For patients with 
      knee OA, intra-articular injection of autologous ASCs or ADSVFs without adjuvant 
      treatment showed remarkable clinical efficacy and safety at short-term follow-up. 
      Some degree of efficacy has been shown for cartilage regeneration in knee OA, 
      although the evidence remains limited. Further RCTs that directly compare ASCs 
      and ADSVFs are needed.
FAU - Kim, Kang-Il
AU  - Kim KI
AD  - Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee 
      University Hospital at Gangdong, Seoul, Republic of Korea.
AD  - Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, 
      Seoul, Republic of Korea.
FAU - Kim, Myung-Seo
AU  - Kim MS
AD  - Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee 
      University Hospital at Gangdong, Seoul, Republic of Korea.
FAU - Kim, Jun-Ho
AU  - Kim JH
AD  - Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee 
      University Hospital at Gangdong, Seoul, Republic of Korea.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Systematic Review
DEP - 20220112
PL  - United States
TA  - Am J Sports Med
JT  - The American journal of sports medicine
JID - 7609541
SB  - IM
MH  - Humans
MH  - *Osteoarthritis, Knee/etiology
MH  - *Mesenchymal Stem Cell Transplantation/methods
MH  - Randomized Controlled Trials as Topic
MH  - Injections, Intra-Articular
MH  - Treatment Outcome
MH  - *Mesenchymal Stem Cells
MH  - Pain/etiology
OTO - NOTNLM
OT  - adipose tissue
OT  - adipose-derived stem cells
OT  - knee osteoarthritis
OT  - mesenchymal stem cell
OT  - stromal vascular fraction
EDAT- 2022/01/13 06:00
MHDA- 2023/03/03 06:00
CRDT- 2022/01/12 12:20
PHST- 2022/01/13 06:00 [pubmed]
PHST- 2023/03/03 06:00 [medline]
PHST- 2022/01/12 12:20 [entrez]
AID - 10.1177/03635465211053893 [doi]
PST - ppublish
SO  - Am J Sports Med. 2023 Mar;51(3):837-848. doi: 10.1177/03635465211053893. Epub 
      2022 Jan 12.