J Knee Surg
DOI: 10.1055/s-0044-1801758
Original Article

Efficacy of Amniotic Suspension Allografts in the Treatment of Knee Osteoarthritis: A Systematic Review

Ayub Ansari
1   Department of Primary Care, Kansas City University College of Osteopathic Medicine, Kansas City, Missouri
,
Mirza Baig
1   Department of Primary Care, Kansas City University College of Osteopathic Medicine, Kansas City, Missouri
,
Yazan Tanbour
1   Department of Primary Care, Kansas City University College of Osteopathic Medicine, Kansas City, Missouri
,
Kazi Syed
1   Department of Primary Care, Kansas City University College of Osteopathic Medicine, Kansas City, Missouri
,
Yunus Ahmed
3   Department of Internal Medicine, Advocate Lutheran General Hospital, Park Ridge, Illinois
,
Bryan G. Beutel
1   Department of Primary Care, Kansas City University College of Osteopathic Medicine, Kansas City, Missouri
2   Department of Orthopedics, Sano Orthopedics, Lee's Summit, Missouri
› Institutsangaben
Funding None.

Abstract

Knee osteoarthritis significantly impacts mobility and quality of life. This condition is a leading cause of disability in aging populations, with total knee replacement commonly sought in advanced cases. Traditional nonoperative management strategies, including anti-inflammatories, corticosteroid injections, and hyaluronic acid, often provide limited relief, especially in severe cases. Recently, regenerative therapies such as amniotic suspension allografts (ASA) have emerged as promising alternatives due to their anti-inflammatory and regenerative properties, which may counteract the catabolic effects of osteoarthritis. This systematic review evaluated the efficacy and safety of ASA in reducing pain and improving function among knee osteoarthritis patients. Following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines, a comprehensive search of PubMed and Embase databases initially identified 1,733 studies pertaining to ASA, of which 1,575 were screened, and 9 studies ultimately met the inclusion criteria for detailed analysis of ASA in the treatment of knee osteoarthritis. Data extraction and narrative synthesis focused on outcomes such as pain reduction and functional improvement using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), as well as safety profiles. The results demonstrated notable improvements in pain scores following ASA treatment, as shown by studies reporting increases in KOOS pain scores over 6 months, which generally outperformed hyaluronic acid and saline treatments in pain reduction. Similarly, ASA treatment was associated with substantial improvements in physical function outcome scores, enhancing patients' ability to perform daily activities. Patient-reported outcomes also indicated higher quality of life and functional status, with most patients experiencing high levels of satisfaction. Additionally, ASA's safety profile was favorable, with adverse events primarily mild to moderate in nature, including a few transient events such as knee stiffness and myalgias. This systematic review highlights ASA as an effective therapeutic option for knee osteoarthritis, although further studies focusing on long-term radiographic outcomes and mechanisms of action are recommended to fully establish its benefits and optimize treatment protocols.



Publikationsverlauf

Eingereicht: 21. Oktober 2024

Angenommen: 10. Dezember 2024

Artikel online veröffentlicht:
10. Januar 2025

© 2025. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Felson DT, Lawrence RC, Dieppe PA. et al. Osteoarthritis: new insights. Part 1: the disease and its risk factors. Ann Intern Med 2000; 133 (08) 635-646
  • 2 Cui A, Li H, Wang D, Zhong J, Chen Y, Lu H. Global, regional prevalence, incidence and risk factors of knee osteoarthritis in population-based studies. EClinicalMedicine 2020; 29–30: 100587
  • 3 Litwic A, Edwards MH, Dennison EM, Cooper C. Epidemiology and burden of osteoarthritis. Br Med Bull 2013; 105: 185-199
  • 4 Guccione AA, Felson DT, Anderson JJ. et al. The effects of specific medical conditions on the functional limitations of elders in the Framingham study. Am J Public Health 1994; 84 (03) 351-358
  • 5 Uivaraseanu B, Vesa CM, Tit DM. et al. Therapeutic approaches in the management of knee osteoarthritis (review). Exp Ther Med 2022; 23 (05) 328
  • 6 Sokolove J, Lepus CM. Role of inflammation in the pathogenesis of osteoarthritis: latest findings and interpretations. Ther Adv Musculoskelet Dis 2013; 5 (02) 77-94
  • 7 Goldring MB, Otero M. Inflammation in osteoarthritis. Curr Opin Rheumatol 2011; 23 (05) 471-478
  • 8 Wolff DG, Christophersen C, Brown SM, Mulcahey MK. Topical nonsteroidal anti-inflammatory drugs in the treatment of knee osteoarthritis: a systematic review and meta-analysis. Phys Sportsmed 2021; 49 (04) 381-391
  • 9 Ayhan E, Kesmezacar H, Akgun I. Intraarticular injections (corticosteroid, hyaluronic acid, platelet rich plasma) for the knee osteoarthritis. World J Orthop 2014; 5 (03) 351-361
  • 10 Sawvell E, Wright N, Ode G, Mercuri J. Perinatal tissue-derived allografts and stromal cells for the treatment of knee osteoarthritis: a review of preclinical and clinical evidence. Cartilage 2022; 13 (04) 184-199
  • 11 Gomoll AH, Farr J, Cole BJ. et al. Safety and efficacy of an amniotic suspension allograft injection over 12 months in a single-blinded, randomized controlled trial for symptomatic osteoarthritis of the knee. Arthroscopy 2021; 37 (07) 2246-2257
  • 12 Natali S, Farinelli L, Screpis D. et al. Human amniotic suspension allograft improves pain and function in knee osteoarthritis: a prospective not randomized clinical pilot study. J Clin Med 2022; 11 (12) 3295
  • 13 Farr J, Gomoll AH, Yanke AB, Strauss EJ, Mowry KC. ASA Study Group. A randomized controlled single-blind study demonstrating superiority of amniotic suspension allograft injection over hyaluronic acid and saline control for modification of knee osteoarthritis symptoms. J Knee Surg 2019; 32 (11) 1143-1154
  • 14 Gomoll AH, Mandelbaum BR, Farr J. et al. An initial injection and a crossover injection of amniotic suspension allograft following failed treatment with hyaluronic acid or saline are equally effective in the treatment of moderate symptomatic knee osteoarthritis over 12 months. Arthroscopy 2023; 39 (01) 66-78
  • 15 Amendola A, Patel SM, Sullivan D. et al. Safety and efficacy results from a phase 1 clinical trial of PTP-001, an injectable placental tissue biologic for knee osteoarthritis. Osteoarthritis Cartilage 2023; 31 (01) x
  • 16 Castellanos R, Tighe S. Injectable amniotic membrane/umbilical cord particulate for knee osteoarthritis: a prospective, single-center pilot study. Pain Med 2019; 20 (11) 2283-2291
  • 17 Campian M, Cushman D, Teramoto M, Flis A. AMSSM oral research poster presentations. Clin J Sport Med 2018; 28: 184-230
  • 18 Hannon CP, Yanke AB, Farr J. Amniotic tissue modulation of knee pain—a focus on osteoarthritis. J Knee Surg 2019; 32 (01) 26-36
  • 19 Vines JB, Aliprantis AO, Gomoll AH, Farr J. Cryopreserved amniotic suspension for the treatment of knee osteoarthritis. J Knee Surg 2016; 29 (06) 443-450
  • 20 Gupta A, Potty AG, Maffulli N. Allogenic platelet-rich plasma for treatment of knee and hip osteoarthritis. Front Pain Res (Lausanne) 2023; 4: 1216190
  • 21 Švajger U, Kolar M, Kobold A, Drobnič M. Mechanisms of treatment effects using allogeneic, umbilical cord-derived mesenchymal stromal stem cells (MSCs) in knee osteoarthritis: a pharmacological clinical study protocol. Trials 2024; 25 (01) 533