1. KEN MAUTNER, MD EMORY SPORTS MEDICINE Clincal Application of PRP and Stem Cells in Knee Osteoarthrits

3. ____________________________ 1 If WBC are present (+) the % of neutrophils should also be reported. 2 The method of exogenous activation should be reported. April, 2015

4. Clinical application of Platelet Rich Plasma for Knee Osteoarthritis

5. AJSM, 2013

6. 1 injection2 injections

8. cid:image001.png@01D0BFB5.76D105 AJSM, 2015

9. cid:image001.png@01D0BFB5.76D105 AJSM, 2015

10. cid:image001.png@01D0BFB5.76D105 AJSM, 2015 Considerations:  Leukocyte Rich (LR) PRP (1.1x baseline)  Freeze/ thaw creates a Platelet Lysate  This is not PRP  PRP was activated with CaCl prior to injection  HA produced sustained benefits at 1 year  Contradicts most studies on HA

11. AJSM, 2014

13. Considerations:  sdsadsa

14. Considerations:  sdsadsa

15. Phase II Study Grade 3-4 Alhback Tibiofemoral OA

16. Conclusion of PRP and OA PRP is a promising treatment for Knee Osteoarthritis  When compared to Hyaluronic acid, PRP seems to have improved outcomes in most studies  L- PRP preferred over L+ PRP Pain and function is improved clinically best at 6 months but also at 1 yr in most studies  Effects are on local environment  Might serve as preventative for further damage  Unlikely to “regenerate” cartilage

17. Injectable Stem Cells for Cartilage Disorders of the Knee

18. Types of Injectable cells for Cartilage Autologous  Bone Marrow  BMA  BMC  Culture/ expanded  Adipose Derived Stem Cells  Lipo-aspirate  SVF  Culture/ expanded Allogenic  Placental Derived Stem Cells

19. Case Reports in Humans Knee OA treated successfully with MSCs using platelet lysate technique  Expanded and cultured  There was a decrease in the VAS by 95%  Increase in ROM by 5 degrees  Increase in cartilage by 19% as measured by MRI at 6 mo follow- up Centeno CJ, Busse D, Kisiday J, Keohan C, Freeman M, Karli D. Increased knee cartilage volume in degenerative joint disease using percutaneously implanted, autologous mesenchymal stem cells. Pain physician. 2008 May- Jun;11(3):343-53.

20. Case Reports in Humans Pre- injection cartilage meniscus 6 months Post- injection cartilage meniscus

21. MSC/ Human Studies Prospective study of 6 females who underwent injection of MSCs without addition of growth factors  1 year follow up  Decrease in mean pain on VAS, joint function, and walking distance compared to baseline No adverse events reported  3 out of 6 showed improvement on MRI in cartilage thickness, extension of repair tissue over subchondral bone, and decrease subchondral edema Archives of Iranian medicine July, 2012

22. 41 patients (75 knees)  84% -- BMAC + ADSC alone  8% -- injection stem cells + Arthroscopy  6% -- injection stem cells+ Arthroscpy/ microfracture  1 -- injection stem cells + Arthroscopy/ HTO Separated by K-L grade of OA  Gr 1: 12, Gr 2: 24, Gr 3: 33, Gr 4: 6 f/u with VAS and functional scales at 3,6, and 12 months 2014

24. Poor results related to K-L OA Grade 2014

25. Compare registry database from 2 different procedures for knee OA  A: 616 Injection of BMAC/ PRP/PL to knee  B: 224 Injection of BMAC/PRP/ PL + ADSC to knee  ADSC placed under collateral ligament at area of meniscal damage on most painful side of knee.

26. Results  Improvement rating (0-100%): 66.2% Group A 74.1% Group B  Improvement LEFS: Inc by 7.9 Group A Inc by 9.8 Group B  Improvement NPS: 4 to 2.6 Group A  Improvement NPS: 4 to 3-3 Group B No significant difference between groups

27. Lipogems

29. Meniscus Regeneration 55 patients s/p partial medial meniscectomy 7-10 days later, single injection given into knee joint of allogenic stem cells  Control: Hyaluronic Acid  A: 50,000,000 allogenic stem cells  B: 150,000,000 allogenic stem cells JBJS, 2014

32. Stem cells, 2014

36. Emory Stem Cell Data Retrospective Outcome Survey  Preliminary Data  First 150 patients who had injectable stem at Emory  December, 2011- August, 2014  Questionnaire > 6 mo. from procedure  Results  60 patients responded (72 joints) BMAC or BMAC + ADSC 23 Hips 32 Knees 17 others  Currently have data on Pain, Function  Will correlate to K-L, BMI, Age, Sex, Psych. profile

37. Pain Pre and > 6 mo. post

38. Function Pre and > 6 mo. post

39. Conclusions for stem cells and cartilage disease Stem cell therapy in orthopedics designed for cartilage repair Injectable bedside treatment is still evolving  Early clinical data for pain relief/ improved function is promising  Data for cartilage “regeneration” is limited Type of stem cells (BMAC vs ADSC) among many factors to be studied to refine procedure

40. kmautne@emory.edu