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Cited by 112Osteoarthritis Treatment and MechanismsPeriodontal Regeneration and TreatmentsKnee injuries and reconstruction techniques

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Comparative Clinical Observation of Arthroscopic Microfracture in the Presence and Absence of a Stromal Vascular Fraction Injection for Osteoarthritis

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Nguyen, Phu Dinh, Tran, Tung Dang-Xuan, Nguyen, Huynh Ton-Ngoc, Vu, Hieu Trung, Le, Phuong Thi-Bich, Phan, Nhan Lu-Chinh, Vu, Ngoc Bich, Phan, Ngoc Kim, Van Pham, Phuc·2017·Stem Cells Translational Medicine
DOI 10.5966/sctm.2016-0023PMC PMC5442736
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Abstract

Osteoarthritis (OA) is a degenerative cartilage disease that is characterized by a local inflammatory reaction. Consequently, many studies have been performed to identify suitable prevention and treatment interventions. In recent years, both arthroscopic microfracture (AM) and stem cell therapy have been used clinically to treat OA. This study aimed to evaluate the clinical effects of AM in the presence and absence of a stromal vascular fraction (SVF) injection in the management of patients with OA. Thirty patients with grade 2 or 3 (Lawrence scale) OA of the knee participated in this study. Placebo group patients (n = 15) received AM alone; treatment group patients (n = 15) received AM and an adipose tissue-derived SVF injection. The SVF was suspended in platelet-rich plasma (PRP) before injection into the joint. Patient groups were monitored and scored with the Western Ontario and McMaster Universities Arthritis Index (WOMAC), Lysholm, Visual Analog Pain Scale (VAS), and modified Outerbridge classifications before treatment and at 6, 12, and 18 months post-treatment. Bone marrow edema was also assessed at these time points. Patients were evaluated for knee activity (joint motion amplitude) and adverse effects relating to surgery and stem cell injection. Treatment efficacy was significantly different between placebo and treatment groups. All treatment group patients had significantly reduced pain and WOMAC scores, and increased Lysholm and VAS scores compared with the placebo group. These findings suggest that the SVF/PRP injection efficiently improved OA for 18 months after treatment. This study will be continuously monitored for additional 24 months.

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Figure 1 WOMAC scores in placebo and treatment groups at 6, 12, and 18 months post‐treatment. After 6 months, WOMAC scores significantly decreased in both the treated and placebo groups. At 12 and 18 months, WOMAC scores continued to decrease in the treatment group and increased in the placebo group. Abbreviation: WOMAC, Western Ontario and McMaster Universities Arthritis Index.
Figure 1 WOMAC scores in placebo and treatment groups at 6, 12, and 18 months post‐treatment. After 6 months, WOMAC scores significantly decreased in both the treated and placebo groups. At 12 and 18 months, WOMAC scores continued to decrease in the treatment group and increased in the placebo group. Abbreviation: WOMAC, Western Ontario and McMaster Universities Arthritis Index.CC BY · PubMed Central
Figure 2 Lysholm scores in placebo and treatment groups at 6, 12, and 18 months post‐treatment. In both treated and placebo groups, the Lysholm score significantly increased at 6 months post‐treatment. At 12 and 18 months post‐treatment, the Lysholm scores of the treatment group continued to increase, whereas those of the placebo group gradually decreased.
Figure 2 Lysholm scores in placebo and treatment groups at 6, 12, and 18 months post‐treatment. In both treated and placebo groups, the Lysholm score significantly increased at 6 months post‐treatment. At 12 and 18 months post‐treatment, the Lysholm scores of the treatment group continued to increase, whereas those of the placebo group gradually decreased.CC BY · PubMed Central
Figure 3 VAS scores at pretreatment and 6, 12, and 18 months post‐treatment in the placebo and treatment groups. VAS scores in the treatment group gradually increased post‐treatment. In the placebo group, scores increased after 6 months and gradually decreased at 12 and 18 months. Abbreviation: VAS, Visual Analog Pain Scale.
Figure 3 VAS scores at pretreatment and 6, 12, and 18 months post‐treatment in the placebo and treatment groups. VAS scores in the treatment group gradually increased post‐treatment. In the placebo group, scores increased after 6 months and gradually decreased at 12 and 18 months. Abbreviation: VAS, Visual Analog Pain Scale.CC BY · PubMed Central
Figure 4 OS and BME scores at pretreatment and 6 and 12 months post‐treatment. Although the changes were nonsignificant, OS scores increased in the placebo group and decreased in the treatment group (A); and BME was significantly decreased in the treatment group 12 months after surgery, and only slightly increased in the placebo group (B). Abbreviations: BME, bone marrow edema; OS, Outerbridge classification system.
Figure 4 OS and BME scores at pretreatment and 6 and 12 months post‐treatment. Although the changes were nonsignificant, OS scores increased in the placebo group and decreased in the treatment group (A); and BME was significantly decreased in the treatment group 12 months after surgery, and only slightly increased in the placebo group (B). Abbreviations: BME, bone marrow edema; OS, Outerbridge classification system.CC BY · PubMed Central
Figure 5 WOMAC and Lysholm scores in stage 2 and 3 osteoarthritis (OA; treatment group). Stromal vascular fraction and platelet‐rich plasma injection significantly improved WOMAC and Lysholm scores in patients with stage 2 OA compared with those with stage 3 disease. Abbreviations: OA, osteoarthritis; WOMAC, Western Ontario and McMaster Universities Arthritis Index.
Figure 5 WOMAC and Lysholm scores in stage 2 and 3 osteoarthritis (OA; treatment group). Stromal vascular fraction and platelet‐rich plasma injection significantly improved WOMAC and Lysholm scores in patients with stage 2 OA compared with those with stage 3 disease. Abbreviations: OA, osteoarthritis; WOMAC, Western Ontario and McMaster Universities Arthritis Index.CC BY · PubMed Central
Figure 6 WOMAC and Lysholm scores in stage 2 and 3 OA treated and placebo groups. Stage 2 patients improved more rapidly compared with stage 3 patients. Abbreviations: OA, osteoarthritis; WOMAC, Western Ontario and McMaster Universities Arthritis Index.
Figure 6 WOMAC and Lysholm scores in stage 2 and 3 OA treated and placebo groups. Stage 2 patients improved more rapidly compared with stage 3 patients. Abbreviations: OA, osteoarthritis; WOMAC, Western Ontario and McMaster Universities Arthritis Index.CC BY · PubMed Central

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Authors
Nguyen, P. D., Tran, T. D.-X., Nguyen, H. T.-N., Vu, H. T., Le, P. T.-B., Phan, N. L.-C., Vu, N. B., Phan, N. K., & Van Pham, P.
Affiliations
  • a 115 Hospital, Ho Chi Minh City, Vietnam
  • b Van Hanh General Hospital, Ho Chi Minh City, Vietnam
  • Vietnam National University Ho Chi Minh City (VN)
  • c Laboratory of Stem Cell Research and Application, University of Science, Vietnam National University, Ho Chi Minh City, Vietnam
ORCID
Venue
Stem Cells Translational Medicine
Publisher
Oxford University Press (OUP)
Published
2016-08-29
Volume
6
Issue
1
Pages
187-195
ISSN
  • 2157-6564 (ISSN-L)
  • 2157-6580
DOI
10.5966/sctm.2016-0023
PMC
PMC5442736
OpenAlex
W2518357713
Cited by
112
References
1
Citations by year
2026: 4 · 2025: 5 · 2024: 14 · 2023: 13 · 2022: 15 · 2021: 12 · 2020: 11 · 2019: 12 · 2018: 16 · 2017: 8 · 2016: 2
FWCI
13.48
Type
journal article
Language
en
Open access
Licence
Locations
  • Stem Cells Translational Medicine (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, other-oa)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Rheumatology › Osteoarthritis Treatment and Mechanisms
  • Health Sciences › Dentistry › Periodontics › Periodontal Regeneration and Treatments
  • Health Sciences › Medicine › Surgery › Knee injuries and reconstruction techniques
Keywords
knee osteoarthritis, arthroscopic microfracture, stromal vascular fraction, adipose-derived stem cells, platelet-rich plasma, cartilage repair, bone marrow edema, analgesia, functional outcome
MeSH terms
Arthroscopy, Bone Marrow, Edema, Female, Humans, Injections, Knee Joint, Magnetic Resonance Imaging, Male, Middle Aged, Fractures, Stress, Treatment Outcome, Stromal Cells, Osteoarthritis, Knee, Visual Analog Scale

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