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Title
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Autologous protein solution as selective treatment for advanced patellofemoral osteoarthritis in the middle-aged female patient : 54% response rate at 1 year follow-up
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Author
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Abstract
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| Purpose The study wanted to investigate the benefit, durability and safety of autologous protein solution (APS) injection(s) in a middle-aged female-only cohort suffering predominantly from patellofemoral osteoarthritis. Methods Fifty females (aged 50.4 +/- 6.5) with mainly moderate-severe (86%) patellofemoral cartilage wear (PFCW) were treated with a unilateral intra-articular APS injection. The KOOS, NRS, Kujala, UCLA and EQ-5D were assessed at baseline and 1, 3, 6, and 12 months post-injection. Therapeutic response rate (TRR) was based on KOOS pain improvement > 10 points. Absolute improvement for, respectively, therapy responders and non-responders was determined. Second APS injection was administered if improvement was deemed insufficient by the patient after 3 months. Results The TRR remained stable averaging to 53.7% at final follow-up with subjects improving overall from 40.3 +/- 18.7 to 57.3 +/- 24.8 points on KOOS pain (p = 0.0002) and from 48.4 +/- 13.0 to 56.3 +/- 18.1 points on Kujala (p = 0.0203) at 12 months. Significant improvement was observed for the other KOOS subscales and NRS at each follow-up. In absolute values, APS responders improved with 30.5 +/- 11.4 points on KOOS pain at 12 months. In contrast, non-responders deteriorated with 5.9 +/- 8.9 points relative to baseline. A second APS injection was administered in 28 subjects. Patients with definite synovitis improved more on KOOS symptoms (p = 0.017) and KOOS ADL (p = 0.037) at 12 months compared to non-synovitis subjects. Mild-moderate arthralgia (46%) and effusion (29%) were commonly observed during the first month post-injection. Conclusion This study evidenced a 54% response rate at 12 months to a single or second APS injection in a middle-aged female population with advanced patellofemoral cartilage wear. Moderate temporary flares can be expected without affecting clinical outcomes. Second APS injection has low efficacy in initially poor responding patients after 3 months. Major synovitis on baseline MRI appeared to be a beneficial prognosticator for pain relief and functional improvement after APS. |
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Language
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English
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Source (journal)
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Knee surgery, sports traumatology, arthroscopy. - Heidelberg, 1993, currens
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Publication
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Heidelberg
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2021
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ISSN
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0942-2056
[print]
1433-7347
[online]
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DOI
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10.1007/S00167-020-06064-8
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Volume/pages
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29
:3
(2021)
, p. 988-997
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ISI
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000535430500001
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Pubmed ID
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32451622
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Full text (Publisher's DOI)
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Full text (publisher's version - intranet only)
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