Osteoarthritis (OA) is a prevalent and debilitating disease characterized by pain, stiffness, and reduced mobility. Its global burden is significant, ranking as the 11th highest contributor to disease burden worldwide. Knee OA, in particular, poses a significant burden due to the joint’s high usage and stress. The impact of OA extends beyond physical discomfort, often affecting mental health, sleep quality, and work productivity.
OA is commonly associated with aging, as the body’s ability to maintain cartilage balance under stress declines over time. Chronic low-grade inflammation also affects disease progression, mediated by pro-inflammatory cytokines that contribute to cartilage breakdown and joint destruction. In addition to local effects, inflammation can lead to neuropathic pain and central sensitization.
Current treatment options for knee OA are limited, including non-pharmacological interventions (e.g., physiotherapy), pain management medications (e.g., Tylenol), and interventional treatments such as nerve blocks or surgery. However, these approaches often provide only symptomatic relief. Knee replacements carry risks of surgical complications, and this is why they are typically the last resort.
Stem cell therapy, particularly mesenchymal stem cells (MSCs), is a promising treatment for knee OA. MSCs offer advantages such as their immuno-evasive nature and immunomodulatory effects. They are obtained from various sources, including bone marrow and adipose tissue, and can be administered as autologous or allogeneic, culture-expanded or matrix-expanded preparations. Meta-analyses have determined that a single intra-articular injection of MSCs is safe and effective for knee OA, with improvements in pain and function observed. However, few studies, if any, have investigated a combination of MSCs injected into the bone and joint space.
We recently presented a case report at the World Institute of Pain (WIP) Conference in Antalya Turkey, as well as the World Academy of Pain Medicine United (WAPMU), where we performed a combined intra-articular and intraosseous MSC injection in a patient with knee OA (Figure 1). The patient, a 42-year-old female police officer with a history of knee trauma, diagnosed with mild-moderate OA, experienced significant improvement in symptoms following treatment.
The patient’s recovery progress over one year demonstrated substantial improvements in knee flexion and pain scores, indicating a near-complete return to pre-injury function. Her case highlights the benefits of our combined intra-articular and intraosseous MSC injections in knee OA management.
