Understanding Osteoarthritis: Symptoms and Pathogenesis
Osteoarthritis is a degenerative joint syndrome characterized by articular cartilage destruction, subchondral bone sclerosis, and cystic degeneration leading to physical limitation and reduced quality of life. The most common symptom is pain followed by stiffness, swelling, and reduced range of motion.
The pathogenesis of osteoarthritis involves an imbalance between catabolic/proinflammatory and anabolic pathways. Free radicals (reactive oxygen species) induce chondrocyte senescence and upregulate inflammatory mediators such as IL-6, ILB-1, and TNF. These cytokines activate other pathways, which activate cytokines that cause disease progression.
Current Treatment Options for Osteoarthritis
Current accepted first-line treatment options include surgical and conservative therapies that provide short-term relief without modifying disease progression. Total knee replacement is commonly performed in refractory cases but results in persistent pain and functional impairment in 20% of patients after 12 months.
Regenerative Therapies: Platelet Rich Plasma and Stem Cells
Consequently, regenerative therapies are required to repair and replace cartilage, alleviate symptoms, and restore joint function.
Common regenerative biologics currently in use include platelet-rich plasma, platelet lysate, bone marrow aspirate, growth factor concentrate, Wharton’s jelly, exosomes, and mesenchymal stem cells derived from adipose tissue.
What are Mesenchymal Stem Cells (MSCs)?
Mesenchymal stem cells have high renewal properties, are proliferative, and have differentiation potential. The most common autologous source is bone marrow aspirate and adipose tissue, typically from abdominal fat. Adipose-derived MSCs are the preferred source over bone marrow because of superior accessibility and lower donor site morbidity. They exert paracrine, anti-inflammatory, and immunomodulatory effects. These results are due to signaling and release of growth factors and cytokines that influence the microenvironment.
Mesenchymal stem cells are known to polarize macrophages and dendritic cells and switch them to the M2 or anti-inflammatory phenotype. Clinical studies demonstrate MSCs have positive effects on osteoarthritis treatment.
The Role of Platelets in Regenerative Medicine
Platelets play a critical role in tissue healing and regeneration. Mechanisms orchestrated by platelets include growth factor release, immune cell interactions, modulation of inflammation, and angiogenesis. Many clinical studies support the actions of platelet-based therapies. Platelet-rich plasma is the autologous use of concentrated blood-derived platelets to achieve repair, revision, and regeneration of various damaged and diseased tissues.
Comparing PRP and Stem Cells for Osteoarthritis
Osteoarthritis-related metabolic imbalances lead to chondrocyte senescence, which then develops into an inflammatory microenvironment with increased release of inflammatory cytokines such as TNF-alpha and IL-B1. These are key players in the progression of the disease. These cytokines stimulate the release of matrix metalloproteinases from chondrocytes, promoting cartilage degradation. Studies have shown that both PRP and adipose-derived mesenchymal stem cells can reduce the expression of TNF-alpha and IL-B1.
As both platelet-rich plasma and mesenchymal stem cells have proven in many studies to be efficacious in the treatment of osteoarthritis, which treatment is better in the long term? Recent studies have addressed this question.
Studies
Bone Marrow Aspirate Concentrate is Equivalent to Platelet Rich Plasma for the Treatment of Knee Osteoarthritis at 1 Year: A Prospective, Randomized Trial
Orthop J Sports Med 2020 Feb 18;8(2):2325967119900958 PMID 32118081
Purpose: To compare the efficacy of BMC to PRP for the treatment of knee OA regarding pain and function at multiple time points up to 12 months after an injection. We hypothesized that bone marrow concentrate will be more effective in improving outcomes in patients with knee OA.
Methods: 90 patients split into two groups and Western Ontario and McMaster University Osteoarthritis Index and International Knee Documentation Committee Scores were documented at 1,3,6,9 and 12 month intervals after ONE injection of platelet rich plasma or bone marrow concentrate.
Conclusion: Both PRP and BMC were effective in improving patient reported outcomes in patients with moderate knee OA for at least 12 months. Neither treatment provided superior clinical benefit over the other. Autologous PRP and BMC showed promising clinical potential as a therapeutic agent for the treatment of OA and while PRP has strong clinical evidence to support its efficacy, BMC has limited support.
A single BMC injection for moderate knee OA was not superior to a single PRP injection for improvement in pain and function questioning the value of the increased invasiveness of the BMC procedure when compared to PRP.
Platelet Rich Plasma versus Microfragmented Adipose Tissue for Knee Osteoarthritis: A Randomized Controlled Trial
Orthop J Sports Med 2022 Sep 16;10(9):23259671221120678 PMID 36147791
Purpose: To compare patient reported outcomes of a single injection of PRP versus MFAT for knee OA.
Although the efficacy of PRP for the treatment of OA of the knee has been demonstrated, other autologous therapeutics that have been developed to treat OA have not undergone the same degree of clinical study. One of these options is microfragmented adipose tissue (MFAT). It is created by performing lipoaspiration at the point of care to obtain autologous adipose tissue. Adipose tissue is the rinsed with saline to remove blood and oil and passed through a filter to make it easier to inject. MFAT contains the cell population of fibroblasts, macrophages, adipocytes, and mesenchymal stem cells.
Conclusion: The most important finding of this study was that both PRP and MFAT resulted in clinically and statistically improvements on all measures for knee OA at 6 months after the injection. Patients in both groups reported similar improvements in pain, mechanical symptoms, functional ability and quality of life.
Numerous randomized trials and meta-analysis support the use of Platelet Rich Plasma for osteoarthritis of the knee. This data has established PRP as the GOLD Standard of orthobiologic interventions. New orthobiologics should be compared with PRP as a benchmark when comparing efficacy and to determine if the increase cost and invasiveness is justified.
The distinct cell populations in MFAT, including mesenchymal stem cells may pique the interest of patients and clinicians. Additionally, processing and harvesting methods used to obtain and create MFAT could lead to the assumption that this is more advanced. However, our study demonstrated PRP is equally effective at 6 months. PRP is simpler to perform, does not require additional training as does lipoaspiration, is less expensive and is easier to repeat as needed.
Microfragmented Adipose Tissue Has No Advantage Over Platelet Rich Plasma and Bone Marrow Aspirate for Symptomatic Knee Osteoarthritis: A Systematic Review and Meta-Analysis
Am J Sports Med 2025 Jan 3:3635465241249940 PMID 39751667
Purpose: To perform a systematic review and meta-analysis comparing microfragmented aspirated fat injections to other orthobiologics for symptomatic osteoarthritis. (bone marrow aspirate and platelet rich plasma)
Results: In 5 studies, there were no significant differences between MFAT, bone marrow aspirate and platelet rich plasma at 3,6 and 12 months.
Conclusion: The results of this systematic review and meta-analysis demonstrated that there were no statistically significant differences for both the clinical outcomes and pain scores between microfragmented adipose tissue and other orthobiologics tested for the treatment of osteoarthritis of the knee.
Authors note: Platelet Rich Plasma is less costly, easier to use, less side effects, no training needed, less cost to the patient, can be used multiple times if needed, virtually no side effects and FDA cleared. The article noted considers it the gold standard of regenerative medicine and all other orthobiologics are to be measure against PRP. Seems to this author, that Platelet Rich Plasma should be in the conversation when treatment options are given to our patients.
Juventix Regenerative Medical: Advancing PRP Technology
Juventix Regenerative Medical is an industry leader in the regenerative medical field. Our Platelet Rich Plasma Kits are FDA cleared and designed for safety, sterility and effectiveness. Our Kits are scientifically manufactured to produce a platelet concentrate, devoid of red blood cells with a minimum number of leukocytes that are critical for the regenerative process.
Juventix Regenerative Medical offers a LED Activator to activate the platelets and begin the regenerative process. This activation is a critical step in the release of growth factors, cytokines and bioactive proteins from the alpha granules on the platelets and is accomplished with LED light. This negates the use of chemical additives such as Calcium Chloride, Thrombin and Collagen. This mode of activation by LED light provides sustained growth factor release versus older methods of activation while adhering to the minimal manipulation standards of the FDA. This activation should be accomplished after the swirl of the centrifuged product to maximize the number of captured platelets.
Juventix Regenerative Medical supplies a patented Bio-Incubator to transform the Platelet Rich Plasma into an Injectable Platelet Rich fibrin. The Platelet Rich Fibrin, commonly called the “second generation of platelet products” has different cytokines and growth factors than the original PRP. These different cytokines provide an anti-inflammatory microenvironment and can be used confidently in inflammatory conditions.
Juventix Regenerative Medical has a vast array of products, devices and services for the regenerative professional. The regenerative marketplace is evolving and transforming daily. With our premier line of products backed by an experienced support staff, Juventix will aid any regenerative professional to provide enhanced therapeutic outcomes, thus increasing patient satisfaction.
RESTORE, REVIVE, REGENERATE- JUVENTIX REGENERATIVE MEDICAL
Regenerative Regards,
Dr. Robert McGrath