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Alternative and complementary therapies in osteoarthritis and cartilage repair.

Abstract：

:Osteoarthritis (OA) is the most common joint condition and, with a burgeoning ageing population, is due to increase in prevalence. Beyond conventional medical and surgical interventions, there are an increasing number of 'alternative' therapies. These alternative therapies may have a limited evidence base and, for this reason, are often only afforded brief reference (or completely excluded) from current OA guidelines. Thus, the aim of this review was to synthesize the current evidence regarding autologous chondrocyte implantation (ACI), mesenchymal stem cell (MSC) therapy, platelet-rich plasma (PRP), vitamin D and other alternative therapies. The majority of studies were in knee OA or chondral defects. Matrix-assisted ACI has demonstrated exceedingly limited, symptomatic improvements in the treatment of cartilage defects of the knee and is not supported for the treatment of knee OA. There is some evidence to suggest symptomatic improvement with MSC injection in knee OA, with the suggestion of minimal structural improvement demonstrated on MRI and there are positive signals that PRP may also lead to symptomatic improvement, though variation in preparation makes inter-study comparison difficult. There is variability in findings with vitamin D supplementation in OA, and the only recommendation which can be made, at this time, is for replacement when vitamin D is deplete. Other alternative therapies reviewed have some evidence (though from small, poor-quality studies) to support improvement in symptoms and again there is often a wide variation in dosage and regimens. For all these therapeutic modalities, although controlled studies have been undertaken to evaluate effectiveness in OA, these have often been of small size, limited statistical power, uncertain blindness and using various methodologies. These deficiencies must leave the question as to whether they have been validated as effective therapies in OA (or chondral defects). The conclusions of this review are that all alternative interventions definitely require clinical trials with robust methodology, to assess their efficacy and safety in the treatment of OA beyond contextual and placebo effects.

journal_name

Aging Clin Exp Res

journal_title

Aging clinical and experimental research

authors

Fuggle NR,Cooper C,Oreffo ROC,Price AJ,Kaux JF,Maheu E,Cutolo M,Honvo G,Conaghan PG,Berenbaum F,Branco J,Brandi ML,Cortet B,Veronese N,Kurth AA,Matijevic R,Roth R,Pelletier JP,Martel-Pelletier J,Vlaskovska M,Thoma

doi

10.1007/s40520-020-01515-1

subject

Has Abstract

pub_date

2020-04-01 00:00:00

pages

547-560

issue

eissn

1594-0667

issn

1720-8319

pii

10.1007/s40520-020-01515-1

journal_volume

pub_type

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Alternative and complementary therapies in osteoarthritis and cartilage repair.