Clinical results and second-look arthroscopic findings after treatment with adipose-derived stem cells for knee osteoarthritis

  • Yong-Gon Koh
  • Yun-Jin Choi
  • Sae-Kwang Kwon
  • Yong-Sang Kim
  • Jee-Eun Yeo



In the present study, the clinical outcomes and second-look arthroscopic findings of intra-articular injection of stem cells with arthroscopic lavage for treatment of elderly patients with knee osteoarthritis (OA) were evaluated.


Stem cell injections combined with arthroscopic lavage were administered to 30 elderly patients (≥65 years) with knee OA. Subcutaneous adipose tissue was harvested from both buttocks by liposuction. After stromal vascular fractions were isolated, a mean of 4.04 × 106 stem cells (9.7 % of 4.16 × 107 stromal vascular fraction cells) were prepared and injected in the selected knees of patients after arthroscopic lavage. Outcome measures included the Knee Injury and Osteoarthritis Outcome Scores, visual analog scale, and Lysholm score at preoperative and 3-, 12-, and 2-year follow-up visits. Sixteen patients underwent second-look arthroscopy.


Almost all patients showed significant improvement in all clinical outcomes at the final follow-up examination. All clinical results significantly improved at 2-year follow-up compared to 12-month follow-up (P < 0.05). Among elderly patients aged >65 years, only five patients demonstrated worsening of Kellgren–Lawrence grade. On second-look arthroscopy, 87.5 % of elderly patients (14/16) improved or maintained cartilage status at least 2 years postoperatively. Moreover, none of the patients underwent total knee arthroplasty during this 2-year period.


Adipose-derived stem cell therapy for elderly patients with knee OA was effective in cartilage healing, reducing pain, and improving function. Therefore, adipose-derived stem cell treatment appears to be a good option for OA treatment in elderly patients.

Level of evidence

Therapeutic case series study, Level IV.


Mesenchymal stem cell Arthroscopic lavage Knee osteoarthritis 


Conflict of interest



  1. 1.
    Abumaree M, Al Jumah M, Pace RA, Kalionis B (2012) Immunosuppressive properties of mesenchymal stem cells. Stem Cell Rev 8:375–392CrossRefPubMedGoogle Scholar
  2. 2.
    Bosnakovski D, Mizuno M, Kim G, Takagi S, Okumura M, Fujinaga T (2006) Chondrogenic differentiation of bovine bone marrow mesenchymal stem cells (MSCs) in different hydrogels: influence of collagen type II extracellular matrix on MSC chondrogenesis. Biotechnol Bioeng 93:1152–1163CrossRefPubMedGoogle Scholar
  3. 3.
    Buckwalter JA, Martin JA (2006) Osteoarthritis. Adv Drug Deliv Rev 58:150–167CrossRefPubMedGoogle Scholar
  4. 4.
    Buckwalter JA, Saltzman C, Brown T (2004) The impact of osteoarthritis: implications for research. Clin Orthop Relat Res 427:S6–15CrossRefPubMedGoogle Scholar
  5. 5.
    Chen FH, Tuan RS (2008) Mesenchymal stem cells in arthritic diseases. Arthritis Res Ther 10:223–234CrossRefPubMedCentralPubMedGoogle Scholar
  6. 6.
    Coleman CM, Curtin C, Barry FP, O’Flatharta C, Murphy JM (2010) Mesenchymal stem cells and osteoarthritis: remedy or accomplice? Hum Gene Ther 21:1239–1250CrossRefPubMedGoogle Scholar
  7. 7.
    Cui JH, Park K, Park SR, Min BH (2006) Effects of low-intensity ultrasound on chondrogenic differentiation of mesenchymal stem cells embedded in polyglycolic acid: an in vivo study. Tissue Eng 12:75–82CrossRefPubMedGoogle Scholar
  8. 8.
    De Toni F, Poglio S, Youcef AB, Cousin B, Pflumio F, Bourin P, Casteilla L, Laharrague P (2011) Human adipose-derived stromal cells efficiently support hematopoiesis in vitro and in vivo: a key step for therapeutic studies. Stem Cells Dev 20:2127–2138CrossRefPubMedGoogle Scholar
  9. 9.
    Desando G, Cavallo C, Sartoni F, Martini L, Parrilli A, Veronesi F, Fini M, Giardino R, Facchini A, Grigolo B (2013) Intra-articular delivery of adipose derived stromal cells attenuates osteoarthritis progression in an experimental rabbit model. Arthritis Res Ther 15:R22–R42CrossRefPubMedCentralPubMedGoogle Scholar
  10. 10.
    Garcia-Olmo D, Garcia-Arranz M, Garcia LG, Cuellar ES, Blanco IF, Prianes LA, Montes JA, Pinto FL, Marcos DH, Garcia-Sancho L (2003) Autologous stem cell transplantation for treatment of rectovaginal fistula in perianal Crohn’s disease: a new cell-based therapy. Int J Colorectal Dis 18:451–454CrossRefPubMedGoogle Scholar
  11. 11.
    Guo X, Wang C, Zhang Y, Xia R, Hu M, Duan C, Zhao Q, Dong L, Lu J, Qing Song Y (2004) Repair of large articular cartilage defects with implants of autologous mesenchymal stem cells seeded into beta-tricalcium phosphate in a sheep model. Tissue Eng 10:1818–1829CrossRefPubMedGoogle Scholar
  12. 12.
    Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502CrossRefPubMedCentralPubMedGoogle Scholar
  13. 13.
    Khan MH (2012) Update on liposuction: clinical pearls. Cutis 90:259–265PubMedGoogle Scholar
  14. 14.
    Kim YS, Park EH, Kim YC, Koh YG (2013) Clinical outcomes of mesenchymal stem cell injection with arthroscopic treatment in older patients with osteochondral lesions of the talus. Am J Sports Med 41:1090–1099CrossRefPubMedGoogle Scholar
  15. 15.
    Klein JA (1990) The tumescent technique. Anesthesia and modified liposuction technique. Dermatol Clin 8:425–437PubMedGoogle Scholar
  16. 16.
    Kocher MS, Steadman JR, Briggs KK, Sterett WI, Hawkins RJ (2004) Reliability, validity, and responsiveness of the Lysholm knee scale for various chondral disorders of the knee. J Bone Joint Surg Am 86-A:1139–1145PubMedGoogle Scholar
  17. 17.
    Koh YG, Choi YJ (2012) Infrapatellar fat pad-derived mesenchymal stem cell therapy for knee osteoarthritis. Knee 19:902–907CrossRefPubMedGoogle Scholar
  18. 18.
    Koh YG, Jo SB, Kwon OR, Suh DS, Lee SW, Park SH, Choi YJ (2013) Mesenchymal stem cell injections improve symptoms of knee osteoarthritis. Arthroscopy 29:748–755CrossRefPubMedGoogle Scholar
  19. 19.
    Kon E, Filardo G, Condello V, Collarile M, Di Martino A, Zorzi C, Marcacci M (2011) Second-generation autologous chondrocyte implantation: results in patients older than 40 years. Am J Sports Med 39:1668–1675CrossRefPubMedGoogle Scholar
  20. 20.
    Marchal JA, Picon M, Peran M, Bueno C, Jimenez-Navarro M, Carrillo E, Boulaiz H, Rodriguez N, Alvarez P, Menendez P, de Teresa E, Aranega A (2012) Purification and long-term expansion of multipotent endothelial-like cells with potential cardiovascular regeneration. Stem Cells Dev 21:562–574CrossRefPubMedGoogle Scholar
  21. 21.
    Maumus M, Guerit D, Toupet K, Jorgensen C, Noel D (2011) Mesenchymal stem cell-based therapies in regenerative medicine: applications in rheumatology. Stem Cell Res Ther 2:14–29CrossRefPubMedCentralPubMedGoogle Scholar
  22. 22.
    Nemeth K, Leelahavanichkul A, Yuen PS, Mayer B, Parmelee A, Doi K, Robey PG, Leelahavanichkul K, Koller BH, Brown JM, Hu X, Jelinek I, Star RA, Mezey E (2009) Bone marrow stromal cells attenuate sepsis via prostaglandin E(2)-dependent reprogramming of host macrophages to increase their interleukin-10 production. Nat Med 15:42–49CrossRefPubMedCentralPubMedGoogle Scholar
  23. 23.
    O’Sullivan J, D’Arcy S, Barry FP, Murphy JM, Coleman CM (2011) Mesenchymal chondroprogenitor cell origin and therapeutic potential. Stem Cell Res Ther 2:8–14CrossRefPubMedCentralPubMedGoogle Scholar
  24. 24.
    Outerbridge RE (1961) The etiology of chondromalacia patellae. J Bone Joint Surg Br 43-B:752–757PubMedGoogle Scholar
  25. 25.
    Puissant B, Barreau C, Bourin P, Clavel C, Corre J, Bousquet C, Taureau C, Cousin B, Abbal M, Laharrague P, Penicaud L, Casteilla L, Blancher A (2005) Immunomodulatory effect of human adipose tissue-derived adult stem cells: comparison with bone marrow mesenchymal stem cells. Br J Haematol 129:118–129CrossRefPubMedGoogle Scholar
  26. 26.
    Reichenbach S, Rutjes AW, Nuesch E, Trelle S, Juni P (2010) Joint lavage for osteoarthritis of the knee. Cochrane Database Syst Rev 5:1–45Google Scholar
  27. 27.
    Riordan NH, Ichim TE, Min WP, Wang H, Solano F, Lara F, Alfaro M, Rodriguez JP, Harman RJ, Patel AN, Murphy MP, Lee RR, Minev B (2009) Non-expanded adipose stromal vascular fraction cell therapy for multiple sclerosis. J Transl Med 7:29–44CrossRefPubMedCentralPubMedGoogle Scholar
  28. 28.
    Risbud MV, Albert TJ, Guttapalli A, Vresilovic EJ, Hillibrand AS, Vaccaro AR, Shapiro IM (2004) Differentiation of mesenchymal stem cells towards a nucleus pulposus-like phenotype in vitro: implications for cell-based transplantation therapy. Spine (Phila Pa 1976) 29:2627–2632CrossRefGoogle Scholar
  29. 29.
    Romanov YA, Darevskaya AN, Merzlikina NV, Buravkova LB (2005) Mesenchymal stem cells from human bone marrow and adipose tissue: isolation, characterization, and differentiation potentialities. Bull Exp Biol Med 140:138–143CrossRefPubMedGoogle Scholar
  30. 30.
    Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD (1998) Knee Injury and Osteoarthritis Outcome Score (KOOS)—development of a self-administered outcome measure. J Orthop Sports Phys Ther 28:88–96CrossRefPubMedGoogle Scholar
  31. 31.
    Scanzello CR, Plaas A, Crow MK (2008) Innate immune system activation in osteoarthritis: is osteoarthritis a chronic wound? Curr Opin Rheumatol 20:565–572CrossRefPubMedGoogle Scholar
  32. 32.
    Schaffler A, Buchler C (2007) Concise review: adipose tissue-derived stromal cells—basic and clinical implications for novel cell-based therapies. Stem Cells 25:818–827CrossRefPubMedGoogle Scholar
  33. 33.
    Tarte K, Gaillard J, Lataillade JJ, Fouillard L, Becker M, Mossafa H, Tchirkov A, Rouard H, Henry C, Splingard M, Dulong J, Monnier D, Gourmelon P, Gorin NC, Sensebe L, Societe Francaise de Greffe de Moelle et Therapie C (2010) Clinical-grade production of human mesenchymal stromal cells: occurrence of aneuploidy without transformation. Blood 115:1549–1553CrossRefPubMedGoogle Scholar
  34. 34.
    ter Huurne M, Schelbergen R, Blattes R, Blom A, de Munter W, Grevers LC, Jeanson J, Noel D, Casteilla L, Jorgensen C, van den Berg W, van Lent PL (2012) Antiinflammatory and chondroprotective effects of intraarticular injection of adipose-derived stem cells in experimental osteoarthritis. Arthritis Rheum 64:3604–3613CrossRefPubMedGoogle Scholar
  35. 35.
    Zuk PA, Zhu M, Mizuno H, Huang J, Futrell JW, Katz AJ, Benhaim P, Lorenz HP, Hedrick MH (2001) Multilineage cells from human adipose tissue: implications for cell-based therapies. Tissue Eng 7:211–228CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Yong-Gon Koh
    • 1
  • Yun-Jin Choi
    • 1
  • Sae-Kwang Kwon
    • 1
  • Yong-Sang Kim
    • 1
  • Jee-Eun Yeo
    • 1
  1. 1.Center for Stem Cell and Arthritis Research, Department of Orthopedic SurgeryYonsei Sarang HospitalSeoulSouth Korea

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