Orthobiologics treatment for meniscal injury with early osteoarthritis of the knee: a case report

Abstract

Meniscal injuries are a common cause of knee pain with functional impairment with early degenerative changes in knee joint. Orthobiologics therapies have emerged as promising, minimally invasive approaches enhancing tissue healing and regeneration. We report case of 50-year-old female presenting with bilateral knee pain, with right knee being more inflammation over one year. Clinical examination revealed mesomorphic build, antalgic gait, swelling, and grade II tenderness over the medial aspect of right knee joint. The numeric pain rating scale (NPRS) score was 7/10. Knee flexion was limited to 100° (right) and 120° (left). Muscle strength using Oxford manual muscle testing (MMT) scale showed knee flexors at 4/5 bilaterally, and knee extensors at 3/5 (right) and 4/5 (left). Magnetic resonance imaging (MRI) demonstrated a radial tear of medial meniscus with mild degenerative changes and joint effusion. The Western Ontario Meniscal Evaluation Tool (WOMET) score was 1055/1600 (34%). The patient underwent autologous bone marrow aspirate concentrate (BMAC) along with enriched platelet-rich plasma (PRP) intra-articularly for two-days under fluoroscopic/ultrasound-guidance. At 9-month follow-up, the patient demonstrated significant clinical improvement. Interestingly, NPRS score reduced (1/10), knee flexion improved to 125° bilaterally, muscle strength to 5/5 in both flexors and extensors and WOMET score to 453/1600 (71.6%). Follow-up magnetic resonance imaging (MRI) showed no evidence of meniscal tear and stable mild osteoarthritic changes without progression. This case demonstrates that intra-articular intervention therapy (BMAC+PRP) serves as an effective non-surgical option for meniscal injuries followed by reduction in pain and functional responses evidenced by radiological outcomes.