Abstract
PURPOSE: To explore the results of a fluoroscopic-guided intra-osseous (IO) and intra-articular (IA) injection of expanded adipose-derived stromal cells (ASCs) in athletes with bone marrow lesions (BML) associated with knee osteoarthritis (OA). METHODS: A prospective study was conducted on 16 athletes (9 males, 7 females; mean age 30.5 ± 2.8 years), including two with bilateral knee involvement. All had Kellgren-Lawrence grades 2-4 and received IA and IO injections of 24.3 ± 2.1 million and 23.4 ± 1.9 million ASCs, respectively. Clinical outcomes were assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS), Numeric Pain Rating Scale (NPRS), and Tegner activity scale at baseline, 6 months, and 12 months. Radiological changes were evaluated using Magnetic Resonance Imaging Osteoarthritis Knee Scores (MOAKS) at baseline and 12 months. RESULTS: Significant improvements were observed in NPRS, Tegner, and all KOOS subscales at 6 months and 12 months with respect to baseline (p < 0.05). At 12 months, NPRS decreased from 6.6 ± 0.9 to 2.4 ± 0.5, and Tegner increased from 4.4 ± 1.8 to 7.8 ± 1.1. All KOOS subscale scores improved at 12 months. Symptoms: 49.3 ± 6.4 to 74.1 ± 4.9; pain: 49.4 ± 4.3 to 75.8 ± 3.2; sport and recreation: 30.6 ± 6.2 to 67.8 ± 4.3; activities of daily living: 57.6 ± 3.6 to 79.9 ± 4.8; and quality of life: 35.4 ± 10.3 to 66.3 ± 5.3. A mild decline yet significant in the KOOS sport and recreation subscale was noted between 6 and 12 months (p = 0.02), but remained significantly improved from baseline. MOAKS analysis showed improvement in 12 of 27 evaluated regions. No major complications occurred. CONCLUSIONS: Combined IA and IO ASC injections are a safe and effective treatment for OA-BMLs in athletes, offering sustained clinical and radiological benefits over 12 months. LEVEL OF EVIDENCE: Level III.