Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland.
J Arthroplasty. 2022 Dec;37(12):2480-2506. doi: 10.1016/j.arth.2022.05.031. Epub 2022 May 21.
Use of "orthobiologics" continues to expand for patients who have knee osteoarthritis (OA). We sought to perform a systemic review of biologic therapies relative to comparative groups, including the following: (1) platelet-rich plasma (PRP); (2) bone marrow-derived mesenchymal stem cells (BMSCs); (3) adipose-derived mesenchymal stem cells (ADSCs); and (4) amniotic-derived mesenchymal stem cells (AMSCs). We assessed the following: (1) study methodologies; (2) cell preparations and formulations; (3) patient-reported outcome scores (PROMs); and (4) structural changes.
PubMed, Cochrane Library, and Embase databases were queried (2013-2021) to conduct a systematic review of biologic therapies for knee OA, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eighty-two studies were included: PRP (51); BMSC (15); ADSC (11); and AMSC (5). Study evaluations were made using the Modified Coleman Methodology Score. PROMs included the Western Ontario and McMaster Universities Arthritis Index and the Visual Analog Scale. Structural change evaluations included ultrasounds, radiographs, or magnetic resonance imaging.
PRP comprised a majority of the studies (n = 51), most with "fair" to "good" Modified Coleman Methodology Score. Studies had variable cell preparations and formulations, with comparison study results leading to inconsistent PROMs, and structural changes. A limited number of studies were included for BMSC, ADSC, and AMSC, all with similar findings to PRP.
Available literature evaluating "orthobiologics" for knee OA remain nonsuperior to comparison cohorts. Higher level studies with larger sample sizes and improved methodologies are warranted to suggest differences. Despite a growth of "orthobiologics" in clinics, this updated systematic review highlights the uncertain efficacy for use in knee OA.
对于患有膝骨关节炎（OA）的患者，“orthobiologics”的应用不断扩大。我们旨在对生物疗法进行系统评价，与对照组进行比较，包括以下内容：（1）富血小板血浆（PRP）；（2）骨髓间充质干细胞（BMSC）；（3）脂肪间充质干细胞（ADSC）；和（4）羊膜间充质干细胞（AMSC）。我们评估了以下内容：（1）研究方法学；（2）细胞制剂和配方；（3）患者报告的结果评分（PROM）；和（4）结构变化。
根据系统评价和荟萃分析的首选报告项目，在 PubMed、Cochrane Library 和 Embase 数据库中查询（2013-2021 年），以进行生物疗法治疗膝骨关节炎的系统评价。共纳入 82 项研究：PRP（51 项）；BMSC（15 项）；ADSC（11 项）；和 AMSC（5 项）。使用改良 Coleman 方法学评分评估研究评估。PROM 包括西部安大略省和麦克马斯特大学关节炎指数和视觉模拟量表。结构变化评估包括超声、射线照相或磁共振成像。
PRP 构成了大多数研究（n=51），其中大多数改良 Coleman 方法学评分为“良好”到“良好”。研究有不同的细胞制剂和配方，由于比较研究结果导致 PROM 不一致，结构变化也不一致。纳入的 BMSC、ADSC 和 AMSC 研究数量有限，结果与 PRP 相似。
评估膝骨关节炎“orthobiologics”的现有文献仍然不比对照组优越。需要进行更高水平的研究，以更大的样本量和改进的方法学来证明差异。尽管“orthobiologics”在临床中的应用不断增加，但本系统评价的更新强调了其在膝骨关节炎中的疗效不确定。
