Knee Osteoarthritis
Conditions
Keywords
mesenchymal stem cell, corticosteroid, adipose stem cell, MRI, pain, Knee
Brief summary
Knee Osteoarthritis (OA) is a common degenerative knee condition of the knee which is treated symptomatically. Knee cartilage tissue has little regenerative ability With the developments in regenerative medicine, stem cells might also be used in knee OA. Recently, adipose tissue has been identified as means for autologous mesenchymal stem cells (aMAT) using non-enzymatic method. Lipogems® is FDA-approved closed-system and directly producing ready-to-use aMAT. Some observational studies showed its potential in knee chondropathy. With no clinical trial done as yet, the investigators will hereby study the comparative efficacy of corticosteroid (current practice) versus Lipogems® in patients with knee OA. The knee MRI changes, clinical and patient-based outcomes will compared between baseline and throughout till 6 months after treatment. This study aims to show the comparative efficacy of Lipogems® as compared to corticosteroid in knee OA patients and to demonstrate its cartilage regeneration potential, which will ultimately deter surgery.
Detailed description
Knee Osteoarthritis (OA) is a common degenerative condition of the knee. Its current management is symptomatic. These patients might eventually need total knee arthroplasty (TKA). With the developments in regenerative medicine, stem cell has been suggested as means to regenerate the knee cartilage tissue which otherwise has little regenerative ability. Initially, stem cells were obtained from bone marrow cells; however, now they can also be obtained from adipose tissue through liposuction. With developments of less invasive liposuction techniques, adipose tissue has been identified as means for autologous mesenchymal stem cells (aMAT). There are two ways of obtaining aMAT form adipose tissue: enzymatic, which has controversies related to Good Manufacturing Practice and low yield, and non-enzymatic method which was recently further developed to a closed-system and directly ready-to-use aMAT producing Lipogems®. Lipogems® is FDA-approved for several applications including orthopedic use. A couple of case reports and cohort studies showed its potential use in knee chondropathy. Until now, no clinical trials compared its effect to the knee OA standard of care which is the intra-articular corticosteroid injection. Here, the investigators will study the comparative efficacy of corticosteroid versus Lipogems® in patients with knee OA. This randomized clinical trial will include 48 patients with symptomatic knee OA ≥ 45 years old with no contraindication of corticosteroid and/or Lipogems® use. These patients will be divided equally into two groups: group S who will receive intra-articular corticosteroid knee injection and group L whose aMAT will be harvested using Lipogems® and be injected intra-articularly. The knee pain, clinical parameters, and patient-related outcome measures (knee injury and osteoarthritis outcome score and Lipogems® Questionnaire-knee) will be assessed at baseline, 2-week, 6-week, 3-month, and 6-month. Also, knee MRI will be done at baseline and 6-months to visualize any changes (MRI Osteoarthritis knee score). These outcomes will be evaluated over the 6-month period and the difference between baseline and follow-up will be compared between the two groups. This study aims to show the comparative efficacy of Lipogems® as compared to corticosteroid in knee OA patients and to demonstrate its cartilage regeneration potential, which will ultimately deter surgery.
Interventions
BIOLOGICALMicrofragmented Adipose Tissue Transplant
Autologous Microfragmented Adipose Tissue derived using Lipogems® Kit
DRUGCorticosteroid injection
intra-articular knee injection of corticosteroid
Sponsors
American University of Beirut Medical Center
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
45 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients who are ≥ 45 years old * Symptomatic knee OA defined as symptoms of knee pain and/or decreased range of motion (ROM) * Classified radiographically as having Grade 2 or 3 Knee OA * Failure of 3-months conservative management (NSAIDs and Physical therapy)
Exclusion criteria
* Patients \< 45 years old * Pregnant or breastfeeding women * Cancer patients * Rheumatoid arthritis patients * Patients having any autoimmune disease affecting the joint * Patients who have had hyaluronic acid injection \<1 year ago * Patients who have undergone lower extremity surgery or trauma on the same side * Hypersensitivity to methylprednisolone (Depo-Medrol®)or any of its components, lidocaine/xylocaine or any of its components, and any of the ingredients of Lipogems® injection kit * Patients with acute systemic or local infection * Patients on anticoagulants (warfarin, coumadin, heparin, Xeralto, or Plavix)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Comparing the total pain score pre- and post-injection differences between the two arms | 6 months | The difference in total pain scores (using numerical rating scale) between the baseline visit (prior to injection) and 6 months after injection will be obtained for each arm. And these differences will be compared between Lipogems and Steroid arms using t-test to assess the effect of each injection type on pain severity |
| Comparing MOAKS pre-and post-injection differences between the two arms | 6 months | The difference in MOAKS values (MRI Osteoarthritis Knee Score) between the baseline visit (prior to injection) and 6 months after injection will be obtained for each arm. And these differences will be compared between Lipogems and Steroid arms using t-test to assess the anatomic effects of each injection type. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Clinical outcomes-stability | 6 months (at 0weeks, 2weeks, 6weeks, 3months, and 6months) | The knee stability (presence/absence) results as assessed by the clinician at baseline (0, pre-injection) and each visit (2 weeks, 6weeks, 3months, and 6months) will be noted and compared between the two arms at each visit timepoint |
| Cartilage thickness | 6 months (at 0weeks & 6months) | Comparing the average difference in thickness of the knee cartilage (in mm), measured on MR image, between the two arms between baseline and 6 months. |
| Clinical outcomes-extension | 6 months (at 0weeks, 2weeks, 6weeks, 3months, and 6months) | The extension lag (in degrees by clinical exam) as assessed by the clinician at baseline (0, pre-injection) and each visit (2 weeks, 6weeks, 3months, and 6months) will be noted and compared between the two arms at each visit timepoint |
| Pain score-other follow-ups | 3 months (at 0weeks, 2weeks, 6weeks, 3months) | The difference in pain scores (numerical rating scale) between the baseline visit (prior to injection) and at each follow-up visit (2 weeks, 6 weeks, 3months) will be obtained for each arm. And these differences will be compared between the two arms. |
| Patient-based outcomes | 6 months (at 0weeks, 2weeks, 6weeks, 3months, and 6months) | The difference scores of patient-based outcome questionnaires (Lipogems® Questionnaire-Knee, and Knee injury and Osteoarthritis Outcome Score or KOOS) between baseline and post-injection follow-ups (2weeks, 6 weeks, 3months, 6 months) will be measured. These difference in scores will be compared between the two arms. |
| Clinical outcomes-flexion | 6 months (at 0weeks, 2weeks, 6weeks, 3months, and 6months) | The flexion range (in degrees by clinical exam) as assessed by the clinician at baseline (0, pre-injection) and each visit (2 weeks, 6weeks, 3months, and 6months) will be noted and compared between the two arms at each visit timepoint |
Countries
Lebanon
Contacts
Primary ContactAsdghig Der-Boghossian/study coordinator
Outcome results
None listed