MANCHESTER — Scientific investigators from Malaysia reported the
first evidence of hyaline cartilage regeneration using intra-articular
injections of autologous peripheral blood stem cells in combination with
In their clinical trial, researchers from the Kuala Lumpur Sports
Medicine Centre and the University Putra Malaysia followed 10 patients with
full-thickness chondral defects treated with arthroscopic multiple subchondral
drilling. The investigators followed the patients for a minimum of 2 years.
After surgery, investigators placed patients’ operated knees on
continuous passive motion for 2 hours a day for 4 weeks, as well as on partial
weight-bearing for the first 6 weeks, lead investigator Khay-Yong Saw,
MCh(Orth), FRCS, said here at the British Orthopaedic Association Annual
Harvesting stem cells
The researchers also harvested autologous peripheral blood stem cells
(PBSCs) using apheresis after surgery. To enable harvesting, an apheresis
catheter was inserted into a large vein at the top of the thigh. The catheter
allows blood to be passed through a cell separator, which filters out stem
cells and returns the processed blood to the body, he said. The harvested PBSCs
were then divided into vials and cryopreserved for future use.
One week after surgery, surgeons aspirated the affected knees and began
injecting five weekly 2.5-ml intra-articular injections of PBSCs mixed with 2
ml hyaluronic acid (HA).
Sequential MRI scans showed that “the subchondral bone began
healing and offered evidence of chondrogenesis,” Saw said. Second-look
arthroscopy with biopsy on four patients also confirmed chondrogenesis as well
as incorporation of the newly regenerated cartilage with the surrounding
This arthroscopic image shows a lateral femoral condyle chondral lesion of a patient’s right knee.
The view of the same knee after subchondral drilling.
Images: Saw K-Y
A second-look arthroscopic image shows healing at 1-year follow-up.
A chondral biopsy identified mature, full-thickness chondrocytes in the
hyaline cartilage, and all patients improved their postoperative IKDC scores,
Saw said. The researchers also saw signs of ongoing remodeling at the 2-year
Saw has since performed the procedure in more than 160 cases.
During the discussion period, co-moderator Gautam Chakrabarty, FRCS,
said the paper was a breakthrough in the field of stem cell research for
cartilage regeneration. “You’re going to put total knee replacement
[surgeons] out of business,” he said.
In his response, Saw acknowledged that the procedure is only one of
several treatment approaches for managing knee arthritis, but “the process
of using stem cells and hyaluronic acid has great potential. This is the
For more information:
- Khay-Yong Saw, MCh(Orth), FRCS, can be reached at Kuala Lumpur
Sports Medicine Centre, 7th Floor, Wisma Perintis, 47 Jalan Dungun, Damansara
Heights, 50490 Kuala Lumpur, Malaysia; +60-3-2096-1033.
- Saw K-Y, Loke S-C, Tay Y-G. A novel approach to neochondrogenesis
induced by peripheral blood stem cells and hyaluronic acid. Presented at the
British Orthopaedic Association Annual Congress 2009. Sept. 15-18, 2009.