Randomized Control Trial Comparison Between Intra-articular Infiltrations of PRP, MFAT, and PRP-MFAT in the Treatment of Symptomatic Knee Osteoarthritis.
Overview
- Phase
- Phase 3
- Intervention
- Not specified
- Conditions
- Osteo Arthritis Knee
- Sponsor
- Assistance Publique Hopitaux De Marseille
- Enrollment
- 180
- Primary Endpoint
- KOOS score at 6 months
- Status
- Not yet recruiting
- Last Updated
- 2 years ago
Overview
Brief Summary
This research protocol evaluate the efficacity of intra-articular injections of autologous microfat associated with a preparation of autologous PRP, in symptomatic, resistant to first-line medical treatment, degenerative or post-traumatic cartilage lesions of the knee.
The primary objective of this study is to show the superiority of intra-articular injection of autologous microfat combined with autologous PRP preparation compared to injection of microfat or PRP used alone, on the KOOS score at 6 months.
Detailed Description
Osteoarthritis is the most widespread joint disease in the world, and one of the most frequent causes of pain and functional disability in Western countries. The incidence of cartilage lesions is constantly on the rise, due to the ageing of the population and the traumas associated with the development of sporting activities. Recently, the emergence of biotherapies in orthopaedics has led to the development of intra-articular injections of autologous platelet-rich plasma (PRP). Their use has been widespread since 2010, based on the demonstration that platelet-enriched plasma, a concentrate of growth factors, can stimulate cartilage regeneration in vitro and in vivo in preclinical models (Saito, Schmidt, Qi, Tchetina). In addition, PRP administration methods can be optimized: since it is a liquid preparation (platelet suspension), administering it within an interface tissue limits its diffusion and potentiates its trophic effect on the injured cartilage site. Adipose tissue represents the most relevant tissue of interest, as it is a stem cell-rich support tissue with full therapeutic potential, and is easily accessible. Thus, a sample of autologous "microfat" (adipose tissue containing small fat lobules and stem cells, harvested under local anaesthetic by manual liposuction using specific fine sampling cannulas) co-administered at the level of the synovial capsule, could play the role of fluid trophic matrix to the PRP. The hypothesis of this project is that the standardized injection of an innovative treatment (microgrease and autologous PRP dose) can defer the need for knee arthroplasty in patients with gonarthrosis resistant to first-line medical treatment. The investigators propose to carry out a clinical study in patients with chondral knee lesions resistant to first-line medical treatment, evaluating the benefit during follow-up of treatment with intra-articular injections of microfat and a standardized preparation of autologous PRP or the combination of the 2.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Patients of both gender, between 20 and 75 year-old.
- •Symptomatics degenerativ or post traumatic chondropathy, on at least one of the 3 knee compartments ICRS grade 2, 3 or 4 with VAS\>4 and failure of well-conducted medical treatment for at least 1 year (palliative analgesics adapted to the pain, AINS, rehabilitation by a physiotherapist, injections intra-articulaires de corticoïdes et/ou d'acide hyaluronique)
- •Varus or valgus less than or equal to 5°.
- •BMI greater than 20 (in order to have sufficient fatty tissue)
- •Informed consent signed by the patient
- •HB \> 10g/dl
- •Negative beta-HCG at inclusion and effective contraception for patients of childbearing age, for 1 month.
- •Beneficiaries of or affiliated to a social security system
Exclusion Criteria
- •Contraindications to MRI : ocular foreign bodies, pacemaker, neurostimulator, cochlear implant, vascular clips, metallic heart valve
- •Body mass index (BMI) of less than 20 kg/m2 not allowig to obtain a sufficient quantity of adipose tissue.
- •Thrombocytopenia \< 150 G/L
- •Thrombocytosis \> 450 G/L
- •Known thrombopathy
- •TP=\> PR \< 70%.
- •TCA=\> APR \> 1.20s
- •Anemia HB \< 10g/dl
- •Positive markers for the following active infectious diseases: HIV 1 and HIV 2 human immunodeficiency virus infection; HTLV I and II virus infection; Hepatitis B virus infection; Hepatitis C virus infection; Syphilis causative agent infection.
- •Use of antiplatelet agents, aspirin, anti-vitamin K drugs for less than 15 days.
Outcomes
Primary Outcomes
KOOS score at 6 months
Time Frame: 6 months
KOOS assesses the short- and long-term consequences of knee injuries, as well as the consequences of primary osteoarthritis. It is percentage from 0 to 100. 0 represents extreme problems and 100 represents no problem.
Secondary Outcomes
- Pain at 3 months(3 months)
- KOOS score at 1 month(1 month)
- Pain at 1 month(1 month)
- KOOS score at 12 months(12 months)
- Proportion of arthroplasties not performed in arthroplasty candidates(12 months)
- Pain at 12 months(12 months)
- Proportion of treatment failures(12 months)
- KOOS score at 3 months(3 months)