Knee

Using Stem Cell Therapy to Treat Osteochondral Defect of the Knee

By June 18, 2019 September 16th, 2019 No Comments

Osteochondritis dissecans (OCD) refers to loose bodies found in joints. The specific reason that these loose pieces emerge is unknown, which has made it difficult to prevent them and to effectively treat them.

Several potential causes of OCD have been put forward, including genetic predisposition, vascular deficiency, and inflammation. Given that athletes appear to suffer from OCD at higher rates than the general population, though, the current thinking on OCD is that small, repetitive trauma likely accounts for this joint phenomenon.

What is most problematic for patients with OCD is often the pain associated with this condition.  The first line of treatment, particularly for children, is to manage OCD without surgical operations. However, non-operative management can vary and includes strategies such as avoiding putting weight on the affected knee, modifying activity, or protecting the knee with a brace.

If these non-operative strategies fail, then surgical approaches such as drilling, fixation, and bone grafting are often undertaken. Nonetheless, even conventional surgeries for OCD management frequently fail, so new therapeutic options for OCD are strongly needed.

Advances in regenerative medicine are offering new opportunities for patients with OCD. A recent case study, published in BMC Musculoskeletal Disorders, demonstrates the potential of stem cells to help this set of patients.

The case study describes a 26-year old man who had been diagnosed with OCD of the right knee at the age of 13. He was suffering from pain that had increased over time, and he had become unable to put weight on his right knee for extended periods. As an athlete, his condition was affecting his ability to perform his job.

Over the course of the 13 years that the patient had had OCD, he had pursued conventional treatment, beginning with non-surgical approaches and then eventually undergoing 7 operations. Unfortunately, none of these interventions were successful in the long-term, making the patient a good candidate for stem cell therapy.

The patient underwent what is known as autologous adipose-derived mesenchymal stem cell therapy, which involved the use of stem cells that came from the patient’s own fat tissue. By using the patient’s own tissue, doctors were able to avoid any potential problems related to immune rejection of foreign tissue.

Results from the therapy were overwhelmingly positive, with improvements observed not only in the patient’s level of pain, but also in terms of his knee’s structure and function. The patient’s pain and function were assessed using a variety of tests, including the Numeric Pain Rating Scale, the Western Ontario and McMaster Universities Arthritis Index and the Knee Injury and Osteoarthritis Outcome Score.

The structural results of the stem cell therapy were evaluated using magnetic resonance imaging (MRI). This imaging technique demonstrated that the stem cell therapy led to cartilage regeneration in the patient’s knee.

These promising results are consistent with other studies and observations showing the significant positive impact of stem cells on a variety of orthopedic injuries and diseases. They provide hope that patients that suffer chronic pain and disability will continue to see newer and more effective therapies for their conditions.

References

Ananthaharan, A., & Randsborg, P.-H. (2018). Epidemiology and patient-reported outcome after juvenile osteochondritis dissecans in the knee. The Knee, 25(4), 595–601. https://doi.org/10.1016/j.knee.2018.02.005

Bauer, K. L., & Polousky, J. D. (2017). Management of Osteochondritis Dissecans Lesions of the Knee, Elbow and Ankle. Clinics in Sports Medicine, 36(3), 469–487. https://doi.org/10.1016/j.csm.2017.02.005

Freitag, J., Shah, K., Wickham, J., Boyd, R., & Tenen, A. (2017). The effect of autologous adipose derived mesenchymal stem cell therapy in the treatment of a large osteochondral defect of the knee following unsuccessful surgical intervention of osteochondritis dissecans – a case study. BMC Musculoskeletal Disorders, 18(1), 298. https://doi.org/10.1186/s12891-017-1658-2

Grimm, N. L., Weiss, J. M., Kessler, J. I., & Aoki, S. K. (2014). Osteochondritis dissecans of the knee: pathoanatomy, epidemiology, and diagnosis. Clinics in Sports Medicine, 33(2), 181–188. https://doi.org/10.1016/j.csm.2013.11.006

Nepple, J. J., Milewski, M. D., & Shea, K. G. (2016). Research in Osteochondritis Dissecans of the Knee: 2016 Update. The Journal of Knee Surgery, 29(7), 533–538. https://doi.org/10.1055/s-0036-1586723

Talusan, P. G., Milewski, M. D., Toy, J. O., & Wall, E. J. (2014). Osteochondritis dissecans of the talus: diagnosis and treatment in athletes. Clinics in Sports Medicine, 33(2), 267–284. https://doi.org/10.1016/j.csm.2014.01.003

Uppstrom, T. J., Gausden, E. B., & Green, D. W. (2016). Classification and assessment of juvenile osteochondritis dissecans knee lesions. Current Opinion in Pediatrics, 28(1), 60–67. https://doi.org/10.1097/MOP.0000000000000308

Dr. Matthew HC Otten

Dr. Matthew HC Otten

Director of Orthopedic & Orthobiologics
Fellowship-trained & Board Certified in Sports medicine
Director Angiography at Harvard Clinical Research Institute
Michigan Stage University Alumni