Download PDF
CC BY-NC-ND 4.0 · Sports Med Int Open 2017; 1(06): E200-E205
DOI: 10.1055/s-0043-118625
Orthopedics & Biomechanics
Eigentümer und Copyright ©Georg Thieme Verlag KG 2017

Intra-Articular Injections of Autologous Conditioned Serum to Treat Pain from Meniscal Lesions

Rudolf Strümper
1   Privatpraxis Orthopädie im Rheinauhafen, Cologne, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
29 September 2017 (online)

    Permissions and Reprints

Abstract

Routine use of biological therapies is in its early stages. Techniques involve stem cells, platelet preparations, recombinant growth factors and autologous conditioned serum, often combined with surgery. The objective of this case analysis was to document effects of intra-articular autologous conditioned serum injections in outpatients with knee pain associated with meniscal defects. Autologous conditioned serum was prepared from patients’ blood by centrifugal separation from cellular components using a specialized device (EOT®II, Orthokine). Outpatients (n=47) with heterogeneous knee meniscus lesions (76.6% traumatic knee injury) were injected once weekly (average 5.2 applications). Average age was 48.6 years (range 21–79). Oxford Knee Score and structural changes with the MRI Boston Leeds Osteoarthritis Knee Score were documented at baseline and 6 months. All analyses were performed retrospectively.

In 83% patients, surgery was avoided during the 6-month observation period. Oxford Knee Score improved significantly from 29.1–44.3 (p<0.001; best possible score=48). Structural findings on MRI, measured by Boston Leeds Osteoarthritis Knee Score, showed significant improvement at 6 months (0.82–0.71, p<0.001). This retrospective study implies that intra-articular autologous conditioned serum injection may be an effective treatment option for knee pain associated with meniscal lesions. Controlled studies of autologous conditioned serum treatment for meniscal lesions are advocated.

Key words

osteoarthritis - intra-articular - ACS - meniscus - biologic - surgery

Refers to:

Sports Medicine International Open – recently publishedInt J Sports Med 2017; 38(14): 1132-1132
DOI: 10.1055/s-0043-123585

 

  • References

  • 1 Freiburger Ethik-Kommission International (FEKI). Available at http://www.ethicscommission.com/ Accessed June 2017
    PubMed
  • 2 Oxford Knee Score. Available at: http://www.orthopaedicscore.com/scorepages/oxford_knee_score.html Accessed July 2017
    PubMed
  • 3 Oxford University Innovation: The Oxford Knee Score (OKS) and Oxford Knee Score–Activity & Participation Questionnaire (OKSAPQ). Available at https://innovation.ox.ac.uk/outcome-measures/oxford-knee-score-activity-participation-questionnaire-oks-apq/ 2015; Accessed July 2017
    PubMed
  • 4 VIP Check International. Available at: http://vipcheck.org Accessed June 2017
    PubMed
  • 5 Baltzer A, Moser C, Jansen S, Krauspe R. Autologous conditioned serum (Orthokine) is an effective treatment for knee osteoarthritis. Osteoarthritis Cartilage 2009; 17: 152-160
    CrossrefPubMedGoogle Scholar
  • 6 Bannuru RR, Schmid CH, Kent DM, Vaysbrot EE, Wong JB, McAlindon TE. Comparative effectiveness of pharmacologic interventions for knee osteoarthritis: A systematic review and network meta-analysis. Ann Intern Med 2015; 162: 46-54
    CrossrefPubMedGoogle Scholar
  • 7 Beard DJ, Harris K, Dawson J, Doll H, Murray DW, Carr AJ, Price AJ. Meaningful changes for the Oxford hip and knee scores after joint replacement surgery. J Clin Epidemiol 2015; 68: 73-79
    CrossrefPubMedGoogle Scholar
  • 8 Becker C, Heidersdorf S, Drewlo S, de Rodriguez SZ, Krämer J, Willburger RE. Efficacy of epidural perineural injections with autologous conditioned serum for lumbar radicular compression: an investigator-initiated, prospective, double-blind, reference-controlled study. Spine (Phila Pa 1976) 2007; 32: 1803-1808
    CrossrefPubMedGoogle Scholar
  • 9 Boilard E, Nigrovic PA, Larabee K, Watts GF, Coblyn JS, Weinblatt ME, Massarotti EM, Remold-O’Donnell E, Farndale RW, Ware J. Platelets amplify inflammation in arthritis via collagen-dependent microparticle production. Science 2010; 327: 580-583
    CrossrefPubMedGoogle Scholar
  • 10 Clement N, MacDonald D, Simpson A. The minimal clinically important difference in the Oxford knee score and Short Form 12 score after total knee arthroplasty. Knee Surg. Sports Traumatol. Arthrosc 2014; 22: 1933-1939
    CrossrefPubMedGoogle Scholar
  • 11 ClinicalTrials.gov. Assessment of outcome of meniscus repair with or without platelet rich plasma: NCT00961597. 2014. Available at: https://clinicaltrials.gov/ct2/show/study/NCT00961597 Accessed September 2016
    PubMed
  • 12 Cohen J. A power primer. Psychol Bull 1992; 112: 155
    CrossrefPubMedGoogle Scholar
  • 13 de Girolamo L, Galliera E, Volpi P, Denti M, Dogliotti G, Quaglia A, Cabitza P, Romanelli MC, Randelli P. Why menisci show higher healing rate when repaired during ACL reconstruction? Growth factors release can be the explanation. Knee Surg Sports Traumatol Arthrosc 2015; 23: 90-96
    CrossrefPubMedGoogle Scholar
  • 14 del Conde I, Crúz MA, Zhang H, López JA, Afshar-Kharghan V. Platelet activation leads to activation and propagation of the complement system. J Exp Med 2005; 201: 871-879
    CrossrefPubMedGoogle Scholar
  • 15 Delos D, Rodeo SA. Enhancing meniscal repair through biology: Platelet-rich plasma as an alternative strategy. Instr Course Lect 2010; 60: 453-460
    PubMedGoogle Scholar
  • 16 Englund M, Guermazi A, Gale D, Hunter DJ, Aliabadi P, Clancy M, Felson DT. Incidental meniscal findings on knee MRI in middle-aged and elderly persons. N Engl J Med 2008; 359: 1108-1115
    CrossrefPubMedGoogle Scholar
  • 17 Englund M, Roos E, Lohmander L. Impact of type of meniscal tear on radiographic and symptomatic knee osteoarthritis: A sixteen-year followup of meniscectomy with matched controls. Arthritis Rheum. 2003; 48: 2178-2187
    CrossrefPubMedGoogle Scholar
  • 18 Evans CH, Chevalier X, Wehling P. Autologous Conditioned Serum. Phys Med Rehabil Clin N Am 2016; 27: 893-908
    CrossrefPubMedGoogle Scholar
  • 19 Felson DT, Lynch J, Guermazi A, Roemer FW, Niu J, McAlindon T, Nevitt MC. Comparison of BLOKS and WORMS scoring systems part II. Longitudinal assessment of knee MRIs for osteoarthritis and suggested approach based on their performance: Data from the Osteoarthritis Initiative. Osteoarthritis Cartilage 2010; 18: 1402-1407
    CrossrefPubMedGoogle Scholar
  • 20 Flick MJ, Chauhan AK, Frederick M, Talmage KE, Kombrinck KW, Miller W, Mullins ES, Palumbo JS, Zheng X, Esmon NL. The development of inflammatory joint disease is attenuated in mice expressing the anticoagulant prothrombin mutant W215A/E217A. Blood 2011; 117: 6326-6337
    CrossrefPubMedGoogle Scholar
  • 21 Frisbie DD, Kawcak CE, Werpy NM, Park RD, McIlwraith CW. Clinical, biochemical, and histologic effects of intra-articular administration of autologous conditioned serum in horses with experimentally induced osteoarthritis. Am J Vet Res 2007; 68: 290-296
    CrossrefPubMedGoogle Scholar
  • 22 García-Escudero JB. Trillos PMH. Treatment of osteoarthritis of the knee with a combination of autologous conditioned serum and physiotherapy: A two-year observational study. PLoS One 2015; 10: e0145551
    CrossrefPubMedGoogle Scholar
  • 23 Goldring SR, Scanzello CR. Plasma proteins take their toll on the joint in osteoarthritis. Arthritis Res Ther 2012; 14: 111
    CrossrefPubMedGoogle Scholar
  • 24 Griffin JW, Hadeed MM, Werner BC, Diduch DR, Carson EW, Miller MD. Platelet-rich plasma in meniscal repair: Does augmentation improve surgical outcomes?. Clin Orthop Relat Res 2015; 473: 1665-1672
    CrossrefPubMedGoogle Scholar
  • 25 Harriss DJ, Atkinson G. Ethical standards in sport and exercise science research: 2016 update. Int J Sports Med 2015; 36: 1121-1124
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Hunter D, Zhang Y, Niu J, Tu X, Amin S, Clancy M, Guermazi A, Grigorian M, Gale D, Felson D. The association of meniscal pathologic changes with cartilage loss in symptomatic knee osteoarthritis. Arthritis Rheum 2006; 54: 795-801
    CrossrefPubMedGoogle Scholar
  • 27 Katz JN, Brophy RH, Chaisson CE, De Chaves L, Cole BJ, Dahm DL, Donnell-Fink LA, Guermazi A, Haas AK, Jones MH. Surgery versus physical therapy for a meniscal tear and osteoarthritis. N Engl J Med 2013; 368: 1675-1684
    CrossrefPubMedGoogle Scholar
  • 28 Khan M, Evaniew N, Bedi A, Ayeni OR, Bhandari M. Arthroscopic surgery for degenerative tears of the meniscus: A systematic review and meta-analysis. Can Med Assoc J 2014; 186: 1057-1064
    CrossrefPubMedGoogle Scholar
  • 29 Kirkley A, Birmingham TB, Litchfield RB, Giffin JR, Willits KR, Wong CJ, Feagan BG, Donner A, Griffin SH, D'Ascanio LM. A randomized trial of arthroscopic surgery for osteoarthritis of the knee. N. Engl. J. Med 2008; 359: 1097-1107
    CrossrefPubMedGoogle Scholar
  • 30 LaPrade RF, Burnett QM, Veenstra MA, Hodgman CG. The prevalence of abnormal magnetic resonance imaging findings in asymptomatic knees with correlation of magnetic resonance imaging to arthroscopic findings in symptomatic knees. Am J Sports Med 1994; 22: 739-745
    CrossrefPubMedGoogle Scholar
  • 31 Lindemann S, Tolley ND, Dixon DA, McIntyre TM, Prescott SM, Zimmerman GA, Weyrich AS. Activated platelets mediate inflammatory signaling by regulated interleukin 1β synthesis. J Cell Biol 2001; 154: 485-490
    CrossrefPubMedGoogle Scholar
  • 32 Lynch JA, Roemer FW, Nevitt MC, Felson DT, Niu J, Eaton CB, Guermazi A. Comparison of BLOKS and WORMS scoring systems part I. Cross sectional comparison of methods to assess cartilage morphology, meniscal damage and bone marrow lesions on knee MRI: data from the osteoarthritis initiative. Osteoarthritis Cartilage 2010; 18: 1393-1401
    CrossrefPubMedGoogle Scholar
  • 33 Majewski M, Ochsner PE, Liu F, Flückiger R, Evans CH. Accelerated healing of the rat Achilles tendon in response to autologous conditioned serum. Am J Sports Med 2009; 37: 2117-2125
    CrossrefPubMedGoogle Scholar
  • 34 McAlindon T, Bannuru RR, Sullivan M, Arden N, Berenbaum F, Bierma-Zeinstra S, Hawker G, Henrotin Y, Hunter D, Kawaguchi H. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis Cartilage 2014; 22: 363-388
    CrossrefPubMedGoogle Scholar
  • 35 Moran CJ, Busilacchi A, Lee CA, Athanasiou KA, Verdonk PC. Biological augmentation and tissue engineering approaches in meniscus surgery. Arthroscopy 2015; 31: 944-955
    CrossrefPubMedGoogle Scholar
  • 36 Moseley JB, O'Malley K, Petersen NJ, Menke TJ, Brody BA, Kuykendall DH, Hollingsworth JC, Ashton CM, Wray NP. A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med 2002; 347: 81-88
    CrossrefPubMedGoogle Scholar
  • 37 Pujol N, De Chou ES, Boisrenoult P, Beaufils P. Platelet-rich plasma for open meniscal repair in young patients: Any benefit?. Knee Surg Sports Traumatol Arthrosc 2015; 23: 51-58
    CrossrefPubMedGoogle Scholar
  • 38 Shelbourne KD, Heinrich J. The long-term evaluation of lateral meniscus tears left in situ at the time of anterior cruciate ligament reconstruction. Arthroscopy 2004; 20: 346-351
    CrossrefPubMedGoogle Scholar
  • 39 Stewart K, Pabbruwe M, Dickinson S, Sims T, Hollander AP, Chaudhuri JB. The effect of growth factor treatment on meniscal chondrocyte proliferation and differentiation on polyglycolic acid scaffolds. Tissue Eng 2007; 13: 271-280
    CrossrefPubMedGoogle Scholar
  • 40 Thorlund JB, Juhl CB, Roos EM, Lohmander L. Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms. Br Med J 2015; 350: h2747
    CrossrefPubMedGoogle Scholar
  • 41 Thornton P, McColl BW, Greenhalgh A, Denes A, Allan SM, Rothwell NJ. Platelet interleukin-1α drives cerebrovascular inflammation. Blood 2010; 115: 3632-3639
    CrossrefPubMedGoogle Scholar
  • 42 Vangsness CT, Farr J, Boyd J, Dellaero DT, Mills CR, LeRoux-Williams M. Adult human mesenchymal stem cells delivered via intra-articular injection to the knee following partial medial meniscectomy. J Bone Joint Surg Am 2014; 96: 90-98
    CrossrefPubMedGoogle Scholar
  • 43 Wehling P, Moser C, Frisbie D, McIlwraith CW, Kawcak CE, Krauspe R, Reinecke JA. Autologous conditioned serum in the treatment of orthopedic diseases: the orthokine therapy. BioDrugs 2007; 21: 323-332
    CrossrefPubMedGoogle Scholar
  • 44 Wright-Carpenter T, Klein P, Schaferhoff P, Appell H, Mir L, Wehling P. Treatment of muscle injuries by local administration of autologous conditioned serum: A pilot study on sportsmen with muscle strains. Int J Sports Med 2004; 25: 588-593
    Article in Thieme ConnectPubMedGoogle Scholar
  • 45 Yu H, Adesida AB, Jomha NM. Meniscus repair using mesenchymal stem cells–a comprehensive review. Stem Cell Res Ther 2015; 6: 86
    CrossrefPubMedGoogle Scholar