Stem Cell Therapy for Knees: Reviews, Evidence, Effectiveness and Cost (2020)

Globally, stem cell therapy is being touted as a miracle cure for everything from wrinkles to spinal repair. However, there is also a lot of misinformation out there. Even among medical groups, the recommendations are conflicting, lacking in depth and out-dated.

We have decided to develop an updated consumer's guide on stem cell therapy for knee osteoarthritis, in order to reduce the confusion.


stem cell therapy for knees

Though very few of these have any scientific backing, stem cell therapy for knees has been the subject of quite a few promising studies.
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Now, in numerous cases, stem cell therapy for knees is reducing pain and repairing cartilage. As a result, many people have been able to improve their quality of life and avoid surgery.

As studies continue, the forms and combinations of stem cell preparations are improving, and outcomes are expected to improve as well.



Stem Cell Therapy for Knee Osteoarthritis Reviews

There are more than 200 studies related to the use of stem cells in treating knee osteoarthritis. However, only controlled clinical trials (human subject research with a comparative group) have been selected below.

Several comparative studies (listed below) have demonstrated good evidence in the treatment of knee osteoarthritis. However, there are several approaches and cell lines used. More well-designed and randomised controlled trials are needed to evaluate the best approach.

Here is the list.

1) Adipose-derived mesenchymal stem cells with microfracture versus microfracture alone: 2-year follow-up of a prospective randomized trial. 

Study: Koh YG, Kwon OR, Kim YS, Choi YJ, Tak DH. Adipose-derived mesenchymal stem cells with microfracture versus microfracture alone: 2-year follow-up of a prospective randomized trial. Arthroscopy 2016; 32:97-109.

Study Method: Unblinded prospective controlled trial

No. of patients: 80


Treatment Method: Compare ADSCs (adipose derived stem cells) with fibrin glue and MFX (microfracture) versus MFX (microfracture) alone for the treatment of cartilage defects in the knee.Conclusion (s): Significantly better signal intensity was observed for the repair tissue in ADSCs with fibrin glue and MFX. Compared with MFX alone, MFX and ADSCs with fibrin glue provided radiologic and KOOS (Knee Injury and Osteoarthritis Outcome Score) pain and symptom sub-score improvements.


2) Injectable cultured bone marrow-derived mesenchymal stem cells in varus knees with cartilage defects undergoing high tibial osteotomy: A prospective, randomized controlled clinical trial with 2 years’ follow-up.

Study: Wong KL, Lee KB, Tai BC, Law P, Lee EH, Hui JH. Injectable cultured bone marrow-derived mesenchymal stem cells in varus knees with cartilage defects undergoing high tibial osteotomy: A prospective, randomized controlled clinical trial with 2 years’ follow-up. Arthroscopy 2013; 29:2020-2028.

Study Method: Prospective unblinded controlled trial

No. of patients: 56

Treatment Method: Intraarticular cultured autologous BM-MSCs (bone marrow mesenchymal stem cells) injections in conjunction with MFX and medial opening-wedge HTO (high tibial osteotomy).

Conclusion (s): The effect of treatment showed an added improvement for IKDC (International Knee Documentation Committee) scores, Lysholm scores, and Tegner scores. MRI scans performed one yr after surgical intervention showed significantly better MOCART scores for the cell-recipient group. Intraarticular injection of cultured MSCs is effective in improving both short-term clinical and MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) outcomes in patients undergoing HTO (high tibial osteotomy) and MFX (Microfracture) for varus knees with cartilage defects.


3) Treatment of knee osteoarthritis with allogeneic bone marrow mesenchymal stem 

cells: A randomized controlled trial.

Study: Vega A, Martín-Ferrero MA, Del Canto F, Alberca M, García V, Munar A, Orozco L, Soler R, Fuertes JJ, Huguet M, Sánchez A, García-Sancho J. Treatment of knee osteoarthritis with allogeneic bone marrow mesenchymal stem cells: A randomized controlled trial. Transplantation 2015; 99:1681-1690.

Study Method: Double blinded controlled trial

No. of patients: 30

Treatment Method: Allogeneic BM-MSC (bone marrow mesenchymal stem cells) by intraarticular injection versus intraarticular HA (hyaluronic acid single-dose 60 mg).

Conclusion (s): The MSC-treated patients displayed significant improvement in functional indices versus the active controls treated with HA. Cartilage quality improvements were noted in the MSC-treated patients. Allogeneic MSC therapy may be a valid alternative for the treatment of chronic KOA that is simple, provides pain relief, and significantly improves cartilage quality.


4) Infrapatellar fat pad-derived mesenchymal stem cell therapy for knee osteoarthritis. 

Study: Koh YG, Choi YJ. Infrapatellar fat pad-derived mesenchymal stem cell therapy for knee osteoarthritis. Knee 2012; 19:902-907.

Study Method: Unblinded controlled trial

No. of patients: 50

Treatment Method: Stem cell with PRP (platelet rich plasma) injections combined with AD (arthroscopic debridement) for treating knee osteoarthritis.

Conclusion (s): Mean Lysholm, Tegner activity scale, and VAS scores of patients in the study group improved significantly by the last follow-up visit. Short-term results of our study demonstrate that infrapatellar fat pad-derived MSC therapy with intraarticular injections is safe and provides assistance in reducing pain and improving function in patients with knee 

osteoarthritis.


5) A controlled clinical trial of adipose derived stem cell transplantation for osteoarthritis. 


Study: Pham PV. A controlled clinical trial of adipose derived stem cell transplantation for osteoarthritis. Cytotherapy 2016; 18:S12-S13.

Study Method: Unblinded controlled trial

No. of patients: 60

Treatment Method: Endocscopic surgery versus endoscopic surgery with ADSC (adipose derived stem cell) injection.

Conclusion (s): All patients in the treated groups significantly reduced pain, reduced the WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) score, and clearly increased the Lyshom scores and VAS scores compared to the control group after 18 months. Injection of autologous mixture of stem cell-enriched stromal efficiently improved the OA after 6 months.


6) Efficacy and safety of adult human bone marrow-derived, cultured, pooled, allogeneic mesenchymal stromal cells (Stempeucel®): Preclinical and clinical trial in osteoarthritis of the knee joint.

Study: Gupta PK, Chullikana A, Rengasamy M, Shetty N, Pandey V, Agarwal V, Wagh SY, Vellotare PK, Damodaran D, Viswanathan P, Thej C, Balasubramanian S, Majumdar AS. Efficacy and safety of adult human bone marrow-derived, cultured, pooled, allogeneic mesenchymal stromal cells (Stempeucel®): Preclinical and clinical trial in osteoarthritis of the knee joint. Arthritis Res Ther 2016; 20; 18:301.

Study Method: Double blinded controlled trial

No. of patients: 60

Treatment Method: The in vitro differentiation potential of adult human bone marrow derived, cultured, pooled, allogeneic MSCs (mesenchymal stem cells) injected into knee joint with different doses of cells (25, 50, 75, or 150 million cells) or placebo.

Conclusion (s): Intraarticular administration of Stempeucel was safe, and a trend towards improvement was seen in the 25-million-cell dose group in all subjective parameters Adverse events were predominant in the higher dose groups. Intraarticular administration of Stempeucel is safe. A 25-million cell dose may be the most effective among the doses tested for pain reduction.



7) Adult human mesenchymal stem cells delivered via intra-articular injection to the knee following partial medial meniscectomy: A randomized, double-blind, controlled study. 

Study: Vangsness CT Jr, Farr J 2nd, Boyd J, Dellaero DT, Mills CR, LeRoux-Williams M. Adult human mesenchymal stem cells delivered via intra-articular injection to the knee following partial medial meniscectomy: A randomized, double-blind, controlled study. J Bone Joint Surg Am 2014; 96:90-98.

Study Method: Randomized, double-blind, controlled study.

No. of patients: 55

Treatment Method: Allogeneic MSCs (mesenchymal stem cells) via intraarticular injection to the knee following partial medial meniscectomy.

Conclusion (s): There was significantly increased meniscal volume determined by quantitative MRI (magnetic resonance imaging) 24% of patients in group A and 6% in group B at 12 months post-meniscectomy. Patients experienced a significant reduction in pain compared to control. There was evidence of meniscus regeneration and improvement in knee pain following treatment with allogeneic human MSCs (mesenchymal stem cells).



8) The new avenues in the management of osteo-arthritis of knee stem cells.

Study: Varma HS, Dadarya B, Vidyarthi A. The new avenues in the management of osteo-arthritis of knee--stem cells. J Indian Med Assoc 2010; 108:583-585.

Study Method: Double-blind, controlled study.

No. of patients: 50

Treatment Method: Group A received arthroscopic debridement alone and group B received buffy coat (mesenchymal stem cell concentrate) injection along with the arthroscopic debridement of the knee.

Conclusion (s): The results suggest that the technique used in the study considerably improved the overall OA outcome score, especially the quality of life within the studied follow-up period and at the end of the follow-up. Buffy coat (MSC concentrate) injection along with the AD of the knee is safe and results in a clinical and functional improvement.



9) Intraarticular injections of HA (hyaluronic acid) with and without PBSC (peripheral blood stem cells). 

Study: Saw KY, Anz A, Siew-Yoke Jee C, Merican S, Ching-Soong Ng R, Roohi SA, Ragavanaidu K. Articular cartilage regeneration with autologous peripheral blood stem cells versus hyaluronic acid: A randomized controlled trial. Arthroscopy 2013; 29:684-694.

Study Method: Randomized, unblinded, controlled study.

No. of patients: 50

Treatment Method: Intra-articular injections of HA with and without PBSC.

Conclusion (s): The total ICRS II (International Cartilage Repair Society Visual Assessment Scale II) histologic scores for the control group averaged 957, and they averaged 1,066 for the intervention group. On evaluation of the MRI morphologic scores, the control group averaged 8.5 and the intervention group averaged 9.9. After arthroscopic subchondral drilling into grade 3 and 4 chondral lesions, postoperative intraarticular injections of autologous PBSC in combination with HA resulted in an improvement of the quality of articular cartilage repair over the same treatment without PBSC (peripheral blood stem cells).


Stem Cell Therapy for Knees Cost


In United States, the cost for stem cell treatment for knees varies from USD 3,000 to 5,000 per knee. In Malaysia, the cost is about half of United States.

Most insurance companies don’t cover stem cell injections yet, but that may be starting to change as more research accumulates showing the effectiveness of the process.

People typically complete the procedure in one visit, but usually have an initial consultation and a follow-up appointment. The injections take approximately two to three hours.


Stem Cell Therapy for Knees Safety and Side effects

Stem cell treatment for knees is non invasive and rarely painful. Side effects are minimal.

The most frequent experiences after the procedure include mild pain at the injection site, swelling, and some joint stiffness.

Although stem cell therapy can pose serious risks when performed on other parts of the body, such as the eyes or the spine, it’s relatively safe when performed on the knees.


Where to go for Stem Cell Therapy for Knees in Malaysia?

If you are in doubt which stem cell therapy centre to go, you can contact us for assistance. Please feel free to submit the form below.

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