Revista de Medicina Desportiva (English) May 2018 | Page 16

Rev. Medicina Desportiva informa, 2018; 9(3):14-17
Minimal Invasive Treatment
of Knee Osteoarthritis:
Corticosteroids, Hyaluronic
Acid or Regenerative
Biological Products?
Dr. José Luís Carvalho 1 , Dr. Gonçalo Borges 2
1
Resident; 2 Specialist doctor. Physical medicine and rehabilitation. Prelada Hospital, Porto.
Abstract
ABSTRACT
Introduction. Therapeutics like hyaluronic acid (HA), platelet rich plasma (PRP) and autologous
mesenchymal stem cells (MSC) have been recognized as alternatives with potential in knee osteoar-
thritis (OA) treatment, in a symptomatic but also regenerative point of view. Material and Methods.
A research in Pubmed database was carried out, concerning the terms “knee osteoarthritis”, “knee
intra-articular” and “knee injections”, (limits: publication date – last 5 years; article type – review
and clinical research). Results. They were obtained 29 articles in the proposed design of this study.
However, a further 4 articles of the research bibliography were added, performing a total of 33
analyzed articles. Discussion and Conclusions. Options like HA, PRP and MSC appear to be alterna-
tives with the potential to alter the OA treatment paradigm, from a pure symptomatic approach to a
minimally invasive perspective with potential for regeneration.
Knee osteoarthritis, intra-articular injections, corticosteroids, hyaluronic acid, platelet rich plasma
and mesenchymal stem cells
Osteoarthritis (OA) is a progressive
degenerative pathology with an
extraordinary impact concerning
pain and impairment on the popula-
tion. However, it also has an impor-
tant expression in younger ages
of specific populations, like high-
competition athletes. Lawrence et al.
stated that even in younger individu-
als the prevalence was very high (>
20% in individuals with > 45 years). 1
The main risk factors related to
the development of OA include age,
obesity, history of trauma or knee
injuries, status postmenopausal in
women, abnormal articulation align-
ment and certain genetic factors. 2
From a pathophysiological point
of view, OA is a more complex
pathology than initially thought, not
depending solely on biomechanical
factors and joint overload, because
highly active processes of inflamma-
tion and joint remodeling are present
in the various stages of the disease.
During the phases of active remode-
ling, enhanced by local inflammatory
14 may 2018 www.revdesportiva.pt
Material and methods
A search was carried out in the
PubMed database of the terms “knee
osteoarthritis”, “knee articular” and
“knee injections”, (Limits: Date of
publication – Last 5 years; type of
article – Review and Clinical Inves-
tigation). From a more specific point
of view, articles were researched
addressing knee articular injection
with corticosteroids (CS), hyaluronic
acid (AH) and recent regenerative
medicine, notably platelet-rich
plasma (Platelet Rich plasma – PRP)
and mesenchymal stem cells (Mesen-
chymal stem Cells – MSC).
Results
KEYWORDS
Introduction
invasive interventions available
for the treatment of the knee OA,
namely the most used therapies and
those with the potential to address
the pathophysiologic processes of
base, thus modulate the evolution of
the disease.
processes, the quality of extracel-
lular matrix is compromised due
to the rapid rate of turnover and
consequent atypical composition
of neo-matriz. 3-5 In this sense, there
is a direct relationship between an
inflammatory environment, changes
in the function of cells, ineffective
synthesis of extracellular matrix and
joint destruction.
The most influential inflammatory
cytokines in the pathophysiologic
process of OA are the interleukin(IL)-
1b, the alpha factor of tumor necro-
sis (TNF-a) and IL-6. Theoretically,
these cytokines contribute to OA
through various mechanisms that
alter the proper functioning of the
chondrocytes, increasing the expres-
sion of catabolic and inflammatory
genes, altering secondarily the struc-
ture and function of the matrix. 6
The treatment of OA is not con-
sensual, presenting pharmacological
approaches, rehabilitation medicine,
minimally invasive treatments and
surgery, among other modalities.
The objective of this investigation
is to address the main minimally
29 articles were obtained at the limits
proposed in the design of this work,
however four more articles men-
tioned in the bibliography obtained in
the research were added, for the rel-
evance of their results and the obvi-
ous validity for the discussion of the
topic, totaling 33 articles analyzed.
Discussion
1. Corticosteroids
The mechanism underlying the
inflammatory effectiveness of the
CS in joint environment is related to
the blockade of the opsonization of
the antigens, adhesion leucocyte and
diapedesis of the cytokines of the
capillary endothelium. At the same
time, this potent anti-inflammatory
decreases the effects of IL-1, reduces
the release of leukotrienes and pros-
taglandins