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Adult Human Mesenchymal Stem Cells Delivered via Intra-Articular Injection to the Knee Following Partial Medial Meniscectomy: A Randomized, Double-Blind, Controlled Study

Vangsness, C. Thomas Jr., MD1; Farr, Jack II, MD2; Boyd, Joel, MD3; Dellaero, David T., MD4; Mills, C. Randal, PhD5; LeRoux-Williams, Michelle, PhD5

doi: 10.2106/JBJS.M.00058
Scientific Articles
Supplementary Content
Disclosures

Background: There are limited treatment options for tissue restoration and the prevention of degenerative changes in the knee. Stem cells have been a focus of intense preclinical research into tissue regeneration but limited clinical investigation. In a randomized, double-blind, controlled study, the safety of the intra-articular injection of human mesenchymal stem cells into the knee, the ability of mesenchymal stem cells to promote meniscus regeneration following partial meniscectomy, and the effects of mesenchymal stem cells on osteoarthritic changes in the knee were investigated.

Methods: A total of fifty-five patients at seven institutions underwent a partial medial meniscectomy. A single superolateral knee injection was given within seven to ten days after the meniscectomy. Patients were randomized to one of three treatment groups: Group A, in which patients received an injection of 50 × 106 allogeneic mesenchymal stem cells; Group B, 150 × 106 allogeneic mesenchymal stem cells; and the control group, a sodium hyaluronate (hyaluronic acid/hyaluronan) vehicle control. Patients were followed to evaluate safety, meniscus regeneration, the overall condition of the knee joint, and clinical outcomes at intervals through two years. Evaluations included sequential magnetic resonance imaging (MRI).

Results: No ectopic tissue formation or clinically important safety issues were identified. There was significantly increased meniscal volume (defined a priori as a 15% threshold) determined by quantitative MRI in 24% of patients in Group A and 6% in Group B at twelve months post meniscectomy (p = 0.022). No patients in the control group met the 15% threshold for increased meniscal volume. Patients with osteoarthritic changes who received mesenchymal stem cells experienced a significant reduction in pain compared with those who received the control, on the basis of visual analog scale assessments.

Conclusions: There was evidence of meniscus regeneration and improvement in knee pain following treatment with allogeneic human mesenchymal stem cells. These results support the study of human mesenchymal stem cells for the apparent knee-tissue regeneration and protective effects.

Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Peer Review This article was reviewed by the Editor-in-Chief and one Deputy Editor, and it underwent blinded review by two or more outside experts. It was also reviewed by an expert in methodology and statistics. The Deputy Editor reviewed each revision of the article, and it underwent a final review by the Editor-in-Chief prior to publication. Final corrections and clarifications occurred during one or more exchanges between the author(s) and copyeditors.

1University of Southern California Orthopaedic Surgery Associates, Keck School of Medicine, 1520 San Pablo Street, Suite 2000, Los Angeles, CA 90033. E-mail address: vangsness@usc.edu

2OrthoIndy, 5255 East Stop 11 Road, Suite 300, Indianapolis, IN 46237

3TRIA Orthopaedic Center, 8100 Northland Drive, Bloomington, MN 55431

4Triangle Orthopaedic Associates, PA, 120 William Penn Plaza, Durham, NC 27704

5Osiris Therapeutics, Inc., 7015 Albert Einstein Drive, Columbia, MD 21046

Copyright © 2014 by The Journal of Bone and Joint Surgery, Incorporated
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