察爾斯大夫 美麗殿堂 Dr. Charles Meridien Palace

Regeneration of human bones in hip Osteonecrosis and human cartilage in knee Osteoarthritis with autologous Adipose-tissue-derived stem cells：a case series（4）

The final case concerns a 79-year-old Korean woman with over seven years' history of bilateral knee pain due to osteoarthritis.

Her left knee was much more painful than the right. Due to her occupation, she made active use of her bilateral knee joints. With a diagnosis of osteoarthritis of both knees, she had received multiple injections of steroids and hyaluronic acid in both knees over the years. However, she noticed no improvement of pain. She was seen by an orthopedic surgeon and was offered a TKR. She was also reluctant to go through the TKR due to possible side effects. Since then, she had been receiving physical therapy with little improvement.

At the time of initial evaluation, she reported severe pain in the left knee (VAS score 8) on rest. The pain was increased when walking. On physical examination, there was deformity of the knee, mild joint swelling, a decreased range of motion and tenderness with flexion. Apley and McMurray tests were negative, and there was no ligamentous laxity.

A pre-treatment 1.5T MRI demonstrated a decreased size and deformed contour on her medial meniscus of the left knee due to maceration. She also underwent the same procedure as our previous patient.

After the fourth week of ADSC injection, her pain improved over 50% and flexion of the knee improved as well. By week 12, her pain had improved over 90% and she was able to flex her knee further (Tables 7 and 8). A repeat MRI taken at week 12 showed a significant increase in the height of her meniscus cartilage on the anterior medial side of the left knee (Figures 5 and 6).

Table 7. Functional rating index and visual analog scale (VAS) score of patient 4

Table 8. Physical therapy (PT) range of motion of patient 4

Figure 5. MRI sagittal T2 view of the knee. Pre-treatment and post-treatment MRI shows increased height of medial meniscus cartilage. The articular cartilage also has a clearer marking, representing probable cartilage regeneration.

Figure 6. MRI coronal T2 view of the knee. The anterior medial meniscus has increased in height.