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Researchers report good first results using blood stem cells, hyaluronic acid to regenerate cartilage

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MANCHESTER — Scientific investigators from Malaysia reported the first evidence of hyaline cartilage regeneration using intra-articular injections of autologous peripheral blood stem cells in combination with hyaluronic acid.

In their clinical trial, researchers from the Kuala Lumpur Sports Medicine Centre and the University Putra Malaysia followed 10 patients with full-thickness chondral defects treated with arthroscopic multiple subchondral drillings. The investigators followed the patients for a minimum of 2 years.

After surgery, investigators placed patients’ operated knees on continuous passive motion for 2 hours a day for 4 weeks, as well as on partial weight-bearing for the first 6 weeks, lead investigator Khay-Yong Saw, MCh(Orth), FRCS, said here at the British Orthopaedic Association Annual Congress 2009.

The researchers also harvested autologous peripheral blood stem cells (PBSCs) using apheresis after surgery. The harvested PBSCs were then divided into vials and cryopreserved for future use, he said.

One week after surgery, they aspirated the affected knees and began injecting five weekly 2.5-ml intra-articular injections of PBSCs mixed with 2 ml hyaluronic acid (HA).

Sequential MRI scans showed that “the subchondral bone began healing and offered evidence of chondrogenesis,” Saw said.

Second-look arthroscopy with biopsy on four patients also confirmed chondrogenesis as well as incorporation of the newly regenerated cartilage with the surrounding articular cartilage, the researchers wrote in their abstract.

A chondral biopsy identified mature, full-thickness chondrocytes in the hyaline cartilage, and all patients improved their postoperative IKDC scores, Saw said. The researchers also saw signs of ongoing remodeling at the 2-year postsurgical mark.

The patients reported no adverse reactions other than the discomfort of the PBSC harvesting process and localized pain associated with the intra-articular injections.

Saw has since performed the procedure in more than 160 cases.

“This is a very simple and cost-effective way of [producing] chondrogenesis,” he said. “Our problem or challenge now is that we aren’t just treating isolated 2-cm lesions. We have since managed to treat the patellofemoral joint and the medial and lateral compartments, and some patients have come to us with severe avascular necrosis, and in those cases, we injected the whole knee [with the mixture].”

Reference:

• Saw K-Y, Loke S-C, Tay Y-G. A novel approach to neochondrogenesis induced by peripheral blood stem cells and hyaluronic acid. Presented at the British Orthopaedic Association Annual Congress 2009. Sept. 15-18, 2009. Manchester.