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Investigation of Mesenchymal Stem Cell Therapy for the Treatment of Osteoarthritis of the Knee

Primary Purpose

Knee Osteoarthritis

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
BMAC injection
PRP injection
Gel-One® hyaluronate injection
Sponsored by
OhioHealth
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Knee Osteoarthritis focused on measuring knee osteoarthritis, regenerative medicine, orthobiologics, cellular therapy

Eligibility Criteria

40 Years - 70 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Male and female patients 40 to 70 years old
  2. Diagnosed with knee osteoarthritis based on the American College of Rheumatology criteria including symptomatic reports and radiographic findings
  3. Kellgren-Lawrence grade 1-3 based on a radiograph within 6 months of presentation to the clinic
  4. Symptomatic evidence of tibiofemoral osteoarthritis for ≥6 months
  5. Average numeric pain rating of 4 - 8 on a scale of zero to 10 (defined as moderate level) over the past week
  6. Previous trial of 6 weeks minimum of conservative therapy including physical therapy, weight loss, anti-inflammatory medication, or injection therapy

Exclusion Criteria:

  1. Grade 4 knee osteoarthritis according to the Kellgren-Lawrence scale
  2. History of intraarticular viscosupplementation or steroid injection in the target knee in the past 6 months at the time of the baseline visit or intraarticular injection planned during the trial
  3. History of arthroscopic surgery in the target knee in the past 12 months at the time of presentation to the clinic or planned surgery during the trial period (e.g., scheduled for/awaiting arthroscopy or a knee replacement procedure)
  4. Bilateral knee osteoarthritis (unless the contralateral knee involvement is limited to radiographic osteoarthritis and not symptomatic)
  5. Ipsilateral (same side) or contralateral (opposite side) symptomatic osteoarthritis of hip or ankle
  6. Clinically apparent tense effusion or other acute inflammation of the target knee at the time of presentation to the clinic
  7. Active infection of either lower extremity such as cellulitis or any skin disease or infection in the area where BMAC is aspirated, blood is drawn, or an injection is given
  8. History of diagnosis of any of the following: 1) septic osteoarthritis of any joint, 2) inflammatory arthropathy such as rheumatoid arthritis, gout, pseudogout, lupus, crystalline arthropathy, chondrocalcinosis and other rheumatology diagnoses
  9. Cruciate/collateral knee ligament instability, ligament laxity, or meniscal instability of the target knee
  10. Significant alignment deformity such as varus/valgus of the target knee in the judgment of the investigator
  11. Currently pregnant, nursing, or planning to become pregnant during the trial period
  12. Previous or known allergic reaction or hypersensitivity to heparin; sodium citrate; hyaluronan products or specifically Gel-One®; cinnamon; bird products such as feathers, eggs, or poultry; avian proteins
  13. Not suitable for BMAC tissue allograft injection per physician (e.g., blood dyscrasia)
  14. Unable to be prescribed stable dose of NSAIDs and/or tramadol based on medical history as ad lib use of over-the-counter analgesics will be allowed in both groups after treatment
  15. Current cigarette smoker
  16. Unable to give informed consent
  17. Non-English speaking

Sites / Locations

  • McConnell Spine, Sport, and Joint Physicians

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

BMAC injection and PRP injection

Gel-One® hyaluronate injection

Arm Description

Injection of bone marrow aspirate concentrate (BMAC) withdrawn from a bone near the hip into the knee joint (intra-articular) immediately followed by an injection of platelet-rich plasma (PRP) into the knee joint.

Gel-One® is an hyaluronate gel used in the treatment of knee osteoarthritis by injection into the knee joint (intra-articular).

Outcomes

Primary Outcome Measures

Knee Injury and Osteoarthritis Outcome Score
Subscales include pain, symptoms, function in activities of daily living, function in sport and recreation, and knee-related quality of life. Each subscale is 0-100 with 100 indicating the best possible score.

Secondary Outcome Measures

Numeric Pain Rating Scale
Scale from 0-10 with 0 representing "no pain" and 10 representing "worst imaginable pain"
Patient Reported Outcome Measurement Information System Global Health Scores
The Patient Reported Outcomes Measurement Information System (PROMIS®) Global Health scale v1.1 contains 10 questions and produces two subscale scores: Global Physical Health (GPH) and Global Mental Health (GMH) (Hays, Bjorner, Revicki, Spritzer, & Cella, 2009). Each subscale produces a raw score that is converted to a T score such that an average patient in the United States would have a subscale T score of 50 with a standard deviation of 10 points ("Global Health: A Brief Guide to the PROMIS® Global Health Instruments", 2017). A score higher than the mean indicates a more desirable score, and vice versa. A positive change score indicates an improvement, while a negative change score indicates a decline in score value.

Full Information

First Posted
November 3, 2016
Last Updated
September 23, 2019
Sponsor
OhioHealth
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1. Study Identification

Unique Protocol Identification Number
NCT02958267
Brief Title
Investigation of Mesenchymal Stem Cell Therapy for the Treatment of Osteoarthritis of the Knee
Official Title
Investigation of Mesenchymal Stem Cell Therapy for the Treatment of Osteoarthritis of the Knee: Effect on Pain and Quality of Life
Study Type
Interventional

2. Study Status

Record Verification Date
September 2019
Overall Recruitment Status
Completed
Study Start Date
December 2016 (undefined)
Primary Completion Date
August 2018 (Actual)
Study Completion Date
August 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
OhioHealth

4. Oversight

5. Study Description

Brief Summary
The purpose of this study is to determine the clinical response to autologous bone marrow aspirate concentrate (BMAC) and platelet-rich plasma (PRP) injections for knee osteoarthritis with respect to pain, function, and quality of life at up to 1 year following the intervention. Specifically, the clinical response will be compared to baseline and a control group treated with a Gel-One® hyaluronate injection to the target knee.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Knee Osteoarthritis
Keywords
knee osteoarthritis, regenerative medicine, orthobiologics, cellular therapy

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
Outcomes Assessor
Allocation
Randomized
Enrollment
32 (Actual)

8. Arms, Groups, and Interventions

Arm Title
BMAC injection and PRP injection
Arm Type
Experimental
Arm Description
Injection of bone marrow aspirate concentrate (BMAC) withdrawn from a bone near the hip into the knee joint (intra-articular) immediately followed by an injection of platelet-rich plasma (PRP) into the knee joint.
Arm Title
Gel-One® hyaluronate injection
Arm Type
Active Comparator
Arm Description
Gel-One® is an hyaluronate gel used in the treatment of knee osteoarthritis by injection into the knee joint (intra-articular).
Intervention Type
Biological
Intervention Name(s)
BMAC injection
Intervention Description
60mL of bone marrow will be collected from a bone near the hip. Approximately 5-6mL of the bone marrow aspirate concentrate is then used for injection, under ultrasound guidance, into the target knee by the study physician.
Intervention Type
Biological
Intervention Name(s)
PRP injection
Intervention Description
60mL of venous blood will be withdrawn from either arm. Approximately 4-5 ml of platelet-rich plasma will be introduced under ultrasound guidance to the subject's target knee by the study physician.
Intervention Type
Device
Intervention Name(s)
Gel-One® hyaluronate injection
Intervention Description
Patients will receive a single injection of Gel-One® (3 ml syringe of Gel-One® - 1% solution [10 mg/mL], 30mg total hyaluronan) into the target knee. Injections will be performed by the study physician under real-time dynamic ultrasound guidance.
Primary Outcome Measure Information:
Title
Knee Injury and Osteoarthritis Outcome Score
Description
Subscales include pain, symptoms, function in activities of daily living, function in sport and recreation, and knee-related quality of life. Each subscale is 0-100 with 100 indicating the best possible score.
Time Frame
Change from baseline to 3, 6, and 12 months post-treatment
Secondary Outcome Measure Information:
Title
Numeric Pain Rating Scale
Description
Scale from 0-10 with 0 representing "no pain" and 10 representing "worst imaginable pain"
Time Frame
Change from baseline to 3, 6, and 12 months post-treatment
Title
Patient Reported Outcome Measurement Information System Global Health Scores
Description
The Patient Reported Outcomes Measurement Information System (PROMIS®) Global Health scale v1.1 contains 10 questions and produces two subscale scores: Global Physical Health (GPH) and Global Mental Health (GMH) (Hays, Bjorner, Revicki, Spritzer, & Cella, 2009). Each subscale produces a raw score that is converted to a T score such that an average patient in the United States would have a subscale T score of 50 with a standard deviation of 10 points ("Global Health: A Brief Guide to the PROMIS® Global Health Instruments", 2017). A score higher than the mean indicates a more desirable score, and vice versa. A positive change score indicates an improvement, while a negative change score indicates a decline in score value.
Time Frame
Change from baseline to 3, 6, and 12 months post-treatment

10. Eligibility

Sex
All
Minimum Age & Unit of Time
40 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male and female patients 40 to 70 years old Diagnosed with knee osteoarthritis based on the American College of Rheumatology criteria including symptomatic reports and radiographic findings Kellgren-Lawrence grade 1-3 based on a radiograph within 6 months of presentation to the clinic Symptomatic evidence of tibiofemoral osteoarthritis for ≥6 months Average numeric pain rating of 4 - 8 on a scale of zero to 10 (defined as moderate level) over the past week Previous trial of 6 weeks minimum of conservative therapy including physical therapy, weight loss, anti-inflammatory medication, or injection therapy Exclusion Criteria: Grade 4 knee osteoarthritis according to the Kellgren-Lawrence scale History of intraarticular viscosupplementation or steroid injection in the target knee in the past 6 months at the time of the baseline visit or intraarticular injection planned during the trial History of arthroscopic surgery in the target knee in the past 12 months at the time of presentation to the clinic or planned surgery during the trial period (e.g., scheduled for/awaiting arthroscopy or a knee replacement procedure) Bilateral knee osteoarthritis (unless the contralateral knee involvement is limited to radiographic osteoarthritis and not symptomatic) Ipsilateral (same side) or contralateral (opposite side) symptomatic osteoarthritis of hip or ankle Clinically apparent tense effusion or other acute inflammation of the target knee at the time of presentation to the clinic Active infection of either lower extremity such as cellulitis or any skin disease or infection in the area where BMAC is aspirated, blood is drawn, or an injection is given History of diagnosis of any of the following: 1) septic osteoarthritis of any joint, 2) inflammatory arthropathy such as rheumatoid arthritis, gout, pseudogout, lupus, crystalline arthropathy, chondrocalcinosis and other rheumatology diagnoses Cruciate/collateral knee ligament instability, ligament laxity, or meniscal instability of the target knee Significant alignment deformity such as varus/valgus of the target knee in the judgment of the investigator Currently pregnant, nursing, or planning to become pregnant during the trial period Previous or known allergic reaction or hypersensitivity to heparin; sodium citrate; hyaluronan products or specifically Gel-One®; cinnamon; bird products such as feathers, eggs, or poultry; avian proteins Not suitable for BMAC tissue allograft injection per physician (e.g., blood dyscrasia) Unable to be prescribed stable dose of NSAIDs and/or tramadol based on medical history as ad lib use of over-the-counter analgesics will be allowed in both groups after treatment Current cigarette smoker Unable to give informed consent Non-English speaking
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Joseph J Ruane, DO
Organizational Affiliation
Medical Director, McConnell Heart Health Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
McConnell Spine, Sport, and Joint Physicians
City
Columbus
State/Province
Ohio
ZIP/Postal Code
43214
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
34434003
Citation
Ruane JJ, Ross A, Zigmont V, McClure D, Gascon G. A Single-Blinded Randomized Controlled Trial of Mesenchymal Stem Cell Therapy for the Treatment of Osteoarthritis of the Knee with Active Control. J Stem Cells Regen Med. 2021 Jan 2;17(1):3-17. doi: 10.46582/jsrm.1701002. eCollection 2021.
Results Reference
derived

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Investigation of Mesenchymal Stem Cell Therapy for the Treatment of Osteoarthritis of the Knee

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