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Refractory Knee Osteoarthritis: Adipose‐Derived Stromal Cells Versus Bone Marrow Aspiration Concentrate
Author(s) -
Malanga Gerard A.,
Dona Samuel,
BorgStein Joanne,
Auriemma Michael,
Singh Jaspal R.
Publication year - 2018
Publication title -
pmandr
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.617
H-Index - 66
eISSN - 1934-1563
pISSN - 1934-1482
DOI - 10.1016/j.pmrj.2018.03.021
Subject(s) - medicine , medical school , rehabilitation , gerontology , physical therapy , medical education
A 56-year-old woman presents to the clinic with a long history of right knee pain. The pain began insidiously 4 years prior and she reports a slow progression in pain and decrease in her function. She has been treated with oral analgesics and anti-inflammatories. In addition, she is currently enrolled in her third round of physical therapy. Last year she had an intra-articular corticosteroid injection, which gave her about 6 weeks of relief. Following this, she underwent a series of 3 hyaluronic acid injections (SupartzFX) that she completed 3 months ago. She reports that this injection did not provide her with significant relief. The patient reports primarily knee pain over the medial joint line. Her alignment is normal and she does not report any swelling, buckling, or locking of her knee. The pain is worse when going up and down stairs, but she does not report any falls. Radiographs and magnetic resonance imaging (MRI) of the right knee reveal moderate to severe tibiofemoral osteoarthritis (Kellen Lawrence grade 3) with mild medial meniscus fraying. There is no discrete meniscus tear, and the anterior and posterior cruciate, and medial and lateral collateral, ligaments are intact. She was reading information on the role of “stem cells” injected into the knee that could regenerate and repair her degeneration. Drs Gerald Malanga and Samuel Dona will argue for adipose-derived stromal cells (ADSCs). Drs Joanne Borg-Stein and Michael Auriemma will argue for bone marrow aspiration concentrate (BMAC).