Autologous protein solution as selective treatment for advanced patellofemoral osteoarthritis in the middle-aged female patient: 54% response rate at 1 year follow-up.
Biological
Conservative
Female
Injection
Joint preservation
Knee
Osteoarthritis
Patellofemoral
Therapy
Journal
Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA
ISSN: 1433-7347
Titre abrégé: Knee Surg Sports Traumatol Arthrosc
Pays: Germany
ID NLM: 9314730
Informations de publication
Date de publication:
Mar 2021
Mar 2021
Historique:
received:
12
02
2020
accepted:
13
05
2020
pubmed:
27
5
2020
medline:
5
5
2021
entrez:
27
5
2020
Statut:
ppublish
Résumé
The study wanted to investigate the benefit, durability and safety of autologous protein solution (APS) injection(s) in a middle-aged female-only cohort suffering predominantly from patellofemoral osteoarthritis. Fifty females (aged 50.4 ± 6.5) with mainly moderate-severe (86%) patellofemoral cartilage wear (PFCW) were treated with a unilateral intra-articular APS injection. The KOOS, NRS, Kujala, UCLA and EQ-5D were assessed at baseline and 1, 3, 6, and 12 months post-injection. Therapeutic response rate (TRR) was based on KOOS pain improvement > 10 points. Absolute improvement for, respectively, therapy responders and non-responders was determined. Second APS injection was administered if improvement was deemed insufficient by the patient after 3 months. The TRR remained stable averaging to 53.7% at final follow-up with subjects improving overall from 40.3 ± 18.7 to 57.3 ± 24.8 points on KOOS pain (p = 0.0002) and from 48.4 ± 13.0 to 56.3 ± 18.1 points on Kujala (p = 0.0203) at 12 months. Significant improvement was observed for the other KOOS subscales and NRS at each follow-up. In absolute values, APS responders improved with 30.5 ± 11.4 points on KOOS pain at 12 months. In contrast, non-responders deteriorated with 5.9 ± 8.9 points relative to baseline. A second APS injection was administered in 28 subjects. Patients with definite synovitis improved more on KOOS symptoms (p = 0.017) and KOOS ADL (p = 0.037) at 12 months compared to non-synovitis subjects. Mild-moderate arthralgia (46%) and effusion (29%) were commonly observed during the first month post-injection. This study evidenced a 54% response rate at 12 months to a single or second APS injection in a middle-aged female population with advanced patellofemoral cartilage wear. Moderate temporary flares can be expected without affecting clinical outcomes. Second APS injection has low efficacy in initially poor responding patients after 3 months. Major synovitis on baseline MRI appeared to be a beneficial prognosticator for pain relief and functional improvement after APS. IV.
Identifiants
pubmed: 32451622
doi: 10.1007/s00167-020-06064-8
pii: 10.1007/s00167-020-06064-8
doi:
Substances chimiques
Blood Proteins
0
Solutions
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
988-997Références
Bay-Jensen AC, Slagboom E, Chen-An P, Alexandersen P, Qvist P, Christiansen C, Meulenbelt I, Karsdal MA (2013) Role of hormones in cartilage and joint metabolism: understanding an unhealthy metabolic phenotype in osteoarthritis. Menopause 20:578–586
doi: 10.1097/gme.0b013e3182745993
Brzusek D, Petron D (2008) Treating knee osteoarthritis with intra-articular hyaluronans. Curr Med Res Opin 24:3307–3322
doi: 10.1185/03007990802490124
Clarke S, Lock V, Duddy J, Sharif M, Newman JH, Kirwan JR (2005) Intra-articular hylan G-F 20 (Synvisc®) in the management of patellofemoral osteoarthritis of the knee (POAK). Knee 12:57–62
doi: 10.1016/j.knee.2004.03.002
Crossley KM, Hinman RS (2011) The patellofemoral joint: the forgotten joint in knee osteoarthritis. Osteoarthritis Cartilage 19:765–767
doi: 10.1016/j.joca.2011.05.005
Crossley KM, Marino GP, Macilquham MD, Schache AG, Hinman RS (2009) Can patellar tape reduce the patellar malalignment and pain associated with patellofemoral osteoarthritis? Arthritis Care Res 61:1719–1725
doi: 10.1002/art.24872
Crossley KM, Vicenzino B, Lentzos J, Schache AG, Pandy MG, Ozturk H, Hinman RS (2015) Exercise, education, manual-therapy and taping compared to education for patellofemoral osteoarthritis: A blinded, randomised clinical trial. Osteoarthritis Cartilage 23:1457–1464
doi: 10.1016/j.joca.2015.04.024
Daghestani HN, Kraus VB (2015) Inflammatory biomarkers in osteoarthritis. Osteoarthritis Cartilage 23:1890–1896
doi: 10.1016/j.joca.2015.02.009
Dejour D, Reynaud P, Lecoultre B (1998) Douleurs et instabilité rotulienne: essai de classification. Médecin et Hygiène 56:1466–1471
van Drumpt R, van der Weegen W, King W, Toler K, KrisMacenski M (2016) Safety and treatment effectiveness of a single autologous protein solution injection in patients with knee osteoarthritis. Biores Open Access 5:261–268
doi: 10.1089/biores.2016.0014
Fosco M, Dagher E (2016) Proposal of a therapeutic protocol for selected patients with patellofemoral knee osteoarthritis: arthroscopic lateral retinacular release followed by viscosupplementation. Musculoskelet Surg 100:171–178
doi: 10.1007/s12306-016-0402-7
Goldring MB (2006) Update on the biology of the chondrocyte and new approaches to treating cartilage diseases. Best Pract Res Clin Rheumatol 20:1003–1025
doi: 10.1016/j.berh.2006.06.003
Goldring MB, Otero M, Tsuchimochi K, Ijiri K, Li Y (2008) Defining the roles of inflammatory and anabolic cytokines in cartilage metabolism. Ann Rheum Dis 67:75–82
doi: 10.1136/ard.2008.098764
Goldring SR, Goldring MB (2004) The role of cytokines in cartilage matrix degeneration in osteoarthritis. Clin Orthop 427S:27–36
doi: 10.1097/01.blo.0000144854.66565.8f
Hame SL, Alexander RA (2013) Knee osteoarthritis in women. Curr Rev Musculoskelet Med 6:182–187
doi: 10.1007/s12178-013-9164-0
Hinman RS, Crossley KM (2007) Patellofemoral joint osteoarthritis: an important subgroup of knee osteoarthritis. Rheumatology 46:1057–1062
doi: 10.1093/rheumatology/kem114
Hinman RS, Lentzos J, Vicenzino B, Crossley KM (2014) Is patellofemoral osteoarthritis common in middle-aged people with chronic patellofemoral pain? Arthritis Care Res 66:1252–1257
doi: 10.1002/acr.22274
Hix J, Klaassen M, Foreman R, Cullen E, Toler K, King W, Woodell-may J (2017) An autologous anti-inflammatory protein solution yielded a favorable safety profile and significant pain relief in an open-label pilot study of patients with osteoarthritis. Biores Open Access 6:151–158
doi: 10.1089/biores.2017.0027
Hunter DJ, Guermazi A, Lo GH, Grainger AJ, Conaghan PG, Boudreau RM, Roemer FW (2011) Evolution of semi-quantitative whole joint assessment of knee OA: MOAKS (MRI Osteoarthritis Knee Score). Osteoarthritis Cartil 19:990–1002
doi: 10.1016/j.joca.2011.05.004
Hunter DJ, Li L, Hirko K, Zhang B, Bennell K (2011) A randomized trial of patellofemoral bracing for treatment of patellofemoral osteoarthritis. Osteoarthritis Cartil 19:792–800
doi: 10.1016/j.joca.2010.12.010
Kim JR, Yoo JJ, Kim HA (2018) Therapeutics in osteoarthritis based on an understanding of its molecular pathogenesis. Int J Mol Sci 19:1–15
King W, Bendele A, Marohl T, Woodell-May J (2017) Human blood-based anti-inflammatory solution inhibits osteoarthritis progression in a meniscal-tear rat study. J Orthop Res 35:2260–2268
doi: 10.1002/jor.23528
King W, van der Weegen W, Van Drumpt R, Soons H, Toler K, Woodell-May J (2016) White blood cell concentration correlates with increased concentrations of IL-1ra and improvement in WOMAC pain scores in an open-label safety study of autologous protein solution. J Exp Orthop 3:1–7
doi: 10.1186/s40634-016-0043-7
Kobayashi S, Pappas E, Fransen M, Refshauge K, Simic M (2016) The prevalence of patellofemoral osteoarthritis: a systematic review and meta-analysis. Osteoarthritis Cartil 24:1697–1707
doi: 10.1016/j.joca.2016.05.011
Kon E, Engebretsen L, Verdonk P, Nehrer S, Filardo G (2018) Clinical outcomes of knee osteoarthritis treated with an autologous protein solution injection: a 1-year pilot double-blinded randomized controlled trial. Am J Sports Med 46:171–180
doi: 10.1177/0363546517732734
Lana JF, Macedo A, Ingrao ILG, Huber SC, Santos GS, Santana MHA (2019) Leukocyte-rich PRP for knee osteoarthritis: current concepts. J Clin Orthop Trauma 10:S179–S182
doi: 10.1016/j.jcot.2019.01.011
Loudon JK (2016) Biomechanics and pathomechanics of the patellofemoral joint. Int J Sports Phys Ther 11:820–830
pubmed: 27904787
pmcid: 5095937
Mueller MB, Tuan RS (2011) Anabolic/catabolic balance in pathogenesis of osteoarthritis: identifying molecular targets. PM&R 3:3–11
doi: 10.1016/j.pmrj.2011.05.009
Muir SM, Reisbig N, Baria M, Kaeding C, Bertone AL (2019) The concentration of plasma provides additional bioactive proteins in platelet and autologous protein solutions. Am J Sports Med 47:1955–1963
doi: 10.1177/0363546519849671
O’Neill TW, Felson DT (2018) Mechanisms of osteoarthritis (OA) pain. Curr Osteoporos Rep Curr Osteoporosis Rep 16:611–616
doi: 10.1007/s11914-018-0477-1
O’Shaughnessey K, Matuska A, Hoeppner J, Farr J, Klaassen M, Kaeding C, Lattermann C, King W, Woodell-May J (2014) Autologous protein solution prepared from the blood of osteoarthritic patients contains an enhanced profile of anti-inflammatory cytokines and anabolic growth factors. J Orthop Res 32:1349–1355
doi: 10.1002/jor.22671
Peat G, Duncan RC, Wood LRJ, Thomas E, Muller S (2012) Clinical features of symptomatic patellofemoral joint osteoarthritis. Arthritis Res Ther 14:1–10
doi: 10.1186/ar3779
Pham T, van der Heijde D, Altman RD, Anderson JJ, Bellamy N, Hochberg M, Simon L, Strand V, Woodworth T, Dougados M (2004) OMERACT-OARSI initiative: osteoarthritis research society international set of responder criteria for osteoarthritis clinical trials revisited. Osteoarthritis Cartil 12:389–399
doi: 10.1016/j.joca.2004.02.001
Riboh JC, Saltzman BM, Yanke AB, Fortier L, Cole BJ (2016) Effect of leukocyte concentration on the efficacy of platelet-rich plasma in the treatment of knee osteoarthritis. Am J Sports Med 44:792–800
doi: 10.1177/0363546515580787
Roos EM, Lohmander LS (2003) The Knee injury and Osteoarthritis Outcome score (KOOS): from joint injury to osteoarthritis. Heal Qual live Outcomes 1:1–8
doi: 10.1186/1477-7525-1-1
Shaughnessey KO, Matuska A, Hoeppner J, Farr J, Klaassen M, Kaeding C, Lattermann C, King W, Woodell-may J (2014) Autologous protein solution prepared from the blood of osteoarthritic patients contains an enhanced profile of anti-inflammatory cytokines and anabolic growth factors. J Orthop Res 32:1349–1355
doi: 10.1002/jor.22671
Sokolove J, Lepus CM (2013) Role of inflammation in the pathogenesis of osteoarthritis: latest findings and interpretations. Ther Adv Musculoskelet Dis 5:77–94
doi: 10.1177/1759720X12467868
Strickland SM, Bird ML, Christ AB (2018) Advances in patellofemoral arthroplasty. Curr Rev Musculoskelet Med 11:221–230
doi: 10.1007/s12178-018-9477-0
Wanstrath AW, Hettlich BF, Su L, Smith A, Zekas LJ, Allen MJ, Bertone AL (2016) Evaluation of a single intra-articular injection of autologous protein solution for treatment of osteoarthritis in a Canine Population. Vet Surg 45:764–774
doi: 10.1111/vsu.12512