Intra-articular injection of culture-expanded mesenchymal stem cells with or without addition of platelet-rich plasma is effective in decreasing pain and symptoms in knee osteoarthritis: A controlled, doublé-blind clinical trial
Open accessAbstract
PURPOSE: To compare the clinical and laboratory outcomes of intra-articular injections of culture-expanded bone-derived mesenchymal stem cells (MSCs) with or without platelet-rich plasma (PRP) to intra-articular corticosteroid injections for the treatment of knee osteoarthritis (OA). METHODS: Forty-seven patients with radiographic and symptomatic knee OA were randomized into three groups for intra-articular injections: autologous bone marrow-derived culture-expanded MSCs (n = 16); autologous bone marrow-derived culture-expanded MSCs + PRP (n = 14); and corticosteroid (n = 17). The outcomes were assessed by the Knee Injury and Osteoarthritis Outcome Score (KOOS) and range of motion (ROM) at baseline, 1, 2, 3, 6, 9 and 12 months and intra-articular cytokines analysis at baseline, 6 and 12 months postoperatively. RESULTS: The three groups showed significant improvement in most KOOS domains and global score at 1st month and all domains and global score at 12-month follow-up (p < 0.05). At the 1st month, only the MSCs group showed significant differences in KOOS symptoms domain (p = 0.003). The MSCs and MSCs + PRP groups showed the highest percentage of improvement in most KOOS domains and global score compared to the corticosteroid group. All three groups showed a significant reduction in intra-articular levels of human interleukin-10 cytokine, from baseline to 12 months (p < 0.05). CONCLUSION: An intra-articular injection of bone marrow-derived culture-expanded MSCs with or without the addiction of PRP is effective in improving the function and decreasing symptoms caused by knee OA at 12-month follow-up. LEVEL OF EVIDENCE: II.
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In patients with knee osteoarthritis, administration of mesenchymal stem cells with or without PRP showed significant improvements in global KOOS and pain scores at 12 months compared to corticosteroids.
“In patients with knee OA, the administration of mesenchymal stem cells (MSCs) with or without PRP showed significant improvements in both the global Knee Injury and Osteoarthritis Outcome Score (KOOS) and pain scores at 12 months compared to corticosteroids”
From Management of platelet-rich plasma and stem cells versus conventional treatments in musculoskeletal injury repair: A systematic review (2025) · cites this paper as [9]
The KOOS score and Discussion sections report significant improvement in the MSC and MSC + PRP groups at 12 months, including global KOOS, and greater percentages of improvement than in the corticosteroid group. They do not establish that the differences versus corticosteroids in global KOOS and pain scores were statistically significant; the reported significance concerns improvement over time. (LLM, conf=0.87)
Experimental — accuracy not yet measuredIn knee osteoarthritis, mesenchymal stem cells with or without PRP produced a statistically significant pain reduction difference of Δ23.2 (P < 0.001) compared to corticosteroids.
“with statistically significant differences in pain reduction ( Δ 23.2, P < 0.001)”
From Management of platelet-rich plasma and stem cells versus conventional treatments in musculoskeletal injury repair: A systematic review (2025) · cites this paper as [9]
The KOOS score and Discussion sections report greater improvement in the MSC and MSC + PRP groups than in the corticosteroid group. They do not establish the claimed statistically significant between-group pain difference of Δ23.2 (P < 0.001); searches for that value and P value found no matching result in our copy. The reported significance concerns improvement from baseline, not the specified comparison. (LLM, conf=0.85)
Experimental — accuracy not yet measuredIn knee osteoarthritis, mesenchymal stem cells with or without PRP produced a statistically significant functional improvement difference of Δ24.0 (P = 0.002) compared to corticosteroids.
“and functional improvement ( Δ 24.0, P = 0.002). [9]”
From Management of platelet-rich plasma and stem cells versus conventional treatments in musculoskeletal injury repair: A systematic review (2025) · cites this paper as [9]
The KOOS score and Discussion sections (page unavailable) report greater functional improvement for the MSC and MSC-plus-PRP groups than for the corticosteroid group at 12 months. They do not report a between-group functional improvement difference of Δ24.0 or P = 0.002; the reported significance concerns improvement over time, not that specific comparison. (LLM, conf=0.86)
Experimental — accuracy not yet measuredIn patients with knee osteoarthritis, cultured MSCs with or without PRP resulted in an IL-10 reduction from 3.33 to 0.52 ng/mL.
“IL-10 reduction in MSCs+PRP: 3.33→0.52 ng/mL.”
From Management of platelet-rich plasma and stem cells versus conventional treatments in musculoskeletal injury repair: A systematic review (2025) · cites this paper as [9]
The Cytokine analysis section (page unavailable) reports a significant reduction in IL-10 from baseline to 12 months in all three groups, including MSCs + PRP. The passages available from our copy do not give the claimed values of 3.33 and 0.52 ng/mL, so the magnitude and units cannot be verified. (LLM, conf=0.86)
Experimental — accuracy not yet measuredIn patients with knee osteoarthritis, cultured MSCs with or without PRP resulted in a KOOS global change of Δ22.7 compared to corticosteroid injection.
“KOOS global: MSCs+PRP Δ22.7.”
From Management of platelet-rich plasma and stem cells versus conventional treatments in musculoskeletal injury repair: A systematic review (2025) · cites this paper as [9]
The KOOS score and Discussion sections report improvement in global KOOS for the MSCs + PRP group over 12 months, with greater improvement than the corticosteroid group. The passages in our copy do not substantiate the specific Δ22.7 figure or show that it is a difference relative to corticosteroid injection; a change from baseline and a between-group difference are not interchangeable. No page number is available for these passages. (LLM, conf=0.82)
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References 50 · Cited by 117
- Authors
- Bastos, R., Mathias, M., Andrade, R., Amaral, R. J. F. C., Schott, V., Balduino, A., Bastos, R., Miguel Oliveira, J., Reis, R. L., Rodeo, S., & Espregueira-Mendes, J.
- Affiliations
- Universidade Federal Fluminense (BR)
- Universidade do Porto (PT)
- Royal College of Surgeons in Ireland (IE)
- 3B's Research Group (PT)
- Hospital for Special Surgery (US)
- ORCID
- Venue
- Knee Surgery, Sports Traumatology, Arthroscopy
- Publisher
- Wiley
- Published
- 2019-10-05
- Volume
- 28
- Issue
- 6
- Pages
- 1989-1999
- ISSN
- 0942-2056 (ISSN-L)
- 1433-7347
- OpenAlex
- W2977829144
- Cited by
- 117
- References
- 50
- Citations by year
- 2026: 4 · 2025: 24 · 2024: 25 · 2023: 17 · 2022: 20 · 2021: 12 · 2020: 15
- FWCI
- 8.91
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Knee Surgery Sports Traumatology Arthroscopy (publishedVersion)
- PubMed (publishedVersion)
- Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Rheumatology › Osteoarthritis Treatment and Mechanisms
- Health Sciences › Medicine › Urology › Periodontal Regeneration and Treatments
- Health Sciences › Medicine › Genetics › Mesenchymal stem cell research
- Keywords
- knee osteoarthritis, mesenchymal stem cells, platelet-rich plasma, intra-articular injection, bone marrow-derived stem cells, corticosteroid injection, KOOS, range of motion, IL-10, analgesia
- MeSH terms
- Adrenal Cortex Hormones, Adult, Aged, Double-Blind Method, Female, Humans, Injections, Intra-Articular, Male, Middle Aged, Pain Measurement, Range of Motion, Articular, Cytokines, Treatment Outcome, Osteoarthritis, Knee, Mesenchymal Stem Cell Transplantation, Platelet-Rich Plasma, Pain Management, Mesenchymal Stem Cells
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