A recent 3 patient case series published out of Stems Medical Clinic in Korea examined the effectiveness of an elixir containing Adipose Derived Stem Cells (ADSCs), Hyaluronic Acid, (HA), and Platelet Rich Plasma (PRP), in treatment of Chondromalacia Patellae. The three patients were selected based on the presence of anterior knee pain, documented presence of Chondromalacia Patallae via MRI, age range under 60, and failure of conservative treatment modalities. The elixir contained 8.5 ml of ADSCs, 4.4 ml of PRP, 2 ml of HA, and .1 ml of CaCl2 (added to activate the platelets).
The complete treatment protocol for the ADSC mixture took place over several weeks. Following cellular extraction and preparation, the 15ml elixir was injected into the retro-patellar joint. On the 3rd and 7th days post-injection, the patients received a second dose of PRP + CaCl2 in combination with 1ml of HA. On the 14th day, a low dose Dexamethasone was added to a dose PRP + CaCl2. Finally, on day 28, the last dose of PRP + CaCl2 was administered.
At one month follow up after the initial injection with ADSCs, the patients reported a 50-70% improvement in pain. Three months post-injection, the patients reported 80-90% improvements. The repeated MRI scans at 3 months follow up illustrated almost complete restoration of damaged tissue (softened cartilages) on the patellae-femoral joints.
Although the exact mechanism of cartilage restoration is unknown, the authors speculated several potential possibilities: direct differentiation of ADSCs, trophic and paracrine effects of ADSCs on existing cartilage, the effects of growth factors present within the PRP, production by chondrocytes stimulated by Dexamethasone, or a combination of the above.
This study is the first report of anterior knee pain reduction and probable cartilage restoration secondary to injection with ADSC mixture. Although larger clinical trials are needed to examine the short and long term efficacy of such treatment, this pilot study presents compelling data suggesting an ADSC mixture as a potential non-surgical treatment option for Chondromalacia Patallae.
Learn more about the latest research bridging surgical and non-surgical orthopedics using biologics at the upcoming TOBI: The Orthobiologic Institute 5th Annual PRP & Regenerative Medicine Symposium with Cadaver Lab, June 6-7, 2014 in Las Vegas. www.prpseminar.com.