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SAGE Publications Sage CA: Los Angeles, CA

10.1177/19476035231201056
10.1177_19476035231201056
Basic Research
Letters to the Editor
Response to Comments by Zhao et al. Regarding “Knee Osteoarthritis: Clinical and MRI Outcomes After Multiple Intra-Articular Injections With Expanded Autologous Adipose-Derived Stromal Cells or Platelet-Rich Plasma”
Khoury Miguel A.
Chamari Karim
Tabben Montassar
Alkhelaifi Khalid
Papacostas Emmanuel
Fermín Theodorakys Marín
Laupheimer Markus
D’Hooghe Pieter
26 10 2023
6 2024
15 2 202203
31 8 2023
31 8 2023
© The Author(s) 2023
2023
SAGE Publications Ltd unless otherwise noted. Manuscript content on this site is licensed under Creative Commons Licenses
https://creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).
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pmcDear Editor and colleagues,

We appreciate your comments and concerns and appreciate academically reaching out to us with an elegant letter and genuine interest in our article “Knee Osteoarthritis: Clinical and MRI Outcomes After Multiple Intra-Articular Injections With Expanded Autologous Adipose-Derived Stromal Cells or Platelet-Rich Plasma.” 1

We agree with your concerns about the wide variety of platelet-rich plasma preparations and the lack of standardization. Likewise, recent systematic reviews have additionally found an alarming lack of reporting quality of the orthobiologics studies.2,3 Our team conducted a systematic review on injectable orthobiologics in professional football players, revealing that less than 10% of the studies reported platelet-rich plasma characteristics. 4 In that sense, our commitment to the scientific community was to ensure adequate reporting of our platelet-rich plasma (as a control group) and adipose-derived stromal cells preparation and treatment following the DOSES guidelines 5 and allowing adequate reproducibility of our study and outcomes. In fact, we are promoting adherence to these reporting guidelines as part of manuscript submissions by editors and reviewers to improve the overall quality of the studies. 6 We strongly believe that improving the reporting quality of orthobiologics studies is the first step to pursuing this so-longed standardization.

On the other hand, contrary to the cited study by Xu et al., 7 our senior author (M.A.K) performed all the ultrasound-guided injections. Thus, the potential lack of accuracy in the delivery due to different ultrasound operators did not cause any bias in our experimental data. Finally, we disagree on implementing second-look arthroscopies in the cartilage assessment of osteoarthritic knee patients. Less-invasive methods, such as delayed gadolinium-enhanced magnetic resonance imaging that allows assessment of glycosaminoglycans concentration in the extracellular cartilage matrix, and thus, cartilage quality, with reliability and no additional morbidities would be our preferred method. 8 Future studies assessing cartilage regeneration with injectable orthobiologics using this magnetic resonance imaging modality will be valuable to the current knowledge.

Miguel A. Khoury* Karim Chamari* Montassar Tabben* Khalid Alkhelaifi* Emmanuel Papacostas* Theodorakys Marín Fermín* Markus Laupheimer* Pieter D’Hooghe**Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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References

1 Khoury MA Chamari K Tabben M Alkhelaifi K Papacostas E Marín Fermín T , et al . Knee osteoarthritis: Clinical and MRI outcomes after multiple intra-articular injections with expanded autologous adipose-derived stromal cells or platelet-rich plasma. Cartilage 2023; 22 :19476035231166127. doi: 10.1177/19476035231166127.
2 Chahla J Cinque ME Piuzzi NS Mannava S Geeslin AG Murray IR , et al . A call for standardization in platelet-rich plasma preparation protocols and composition reporting: a systematic review of the clinical orthopaedic literature. J Bone Joint Surg Am. 2017;99 (20 ):1769-79. doi:10.2106/JBJS.16.01374.
3 DeClercq MG Fiorentino AM Lengel HA Ruzbarsky JJ Robinson SK Oberlohr VT , et al . Systematic review of platelet-rich plasma for rotator cuff repair: are we adhering to the minimum information for studies evaluating biologics in orthopaedics? Orthop J Sports Med. 2021;9 (12 ):23259671211041971. doi:10.1177/23259671211041971. 34901286
4 Marín Fermín T Papakostas E Macchiarola L Zampeli F Kalifis G De Girolamo L , et al . Injectable orthobiologics in professional football (soccer) players: a systematic review. J Cartil Joint Preserv. 2022;2 (2 ):100050. doi:10.1016/j.jcjp.2022.100050.
5 Murray IR Chahla J Safran MR Krych AJ Saris DBF Caplan AI , et al . International expert consensus on a cell therapy communication tool: DOSES. J Bone Joint Surg Am. 2019;101 (10 ):904-11. doi:10.2106/JBJS.18.00915.
6 Marín Fermín T Scarlat MM Laupheimer MW . Would you have an injection without knowing its formula? New challenges in platelet-rich plasma therapy. Int Orthop. 2022;46 (10 ):2179-80. doi:10.1007/s00264-022-05566-z.
7 Xu Z He Z Shu L Li X Ma M Ye C . Intra-articular platelet-rich plasma combined with hyaluronic acid injection for knee osteoarthritis is superior to platelet-rich plasma or hyaluronic acid alone in inhibiting inflammation and improving pain and function. Arthroscopy. 2021;37 (3 ):903-15. doi:10.1016/j.arthro.2020.10.013.
8 Bekkers JE Bartels LW Benink RJ Tsuchida AI Vincken KL Dhert WJ , et al . Delayed gadolinium enhanced MRI of cartilage (dGEMRIC) can be effectively applied for longitudinal cohort evaluation of articular cartilage regeneration. Osteoarthritis Cartilage. 2013;21 (7 ):943-9. doi:10.1016/j.joca.2013.03.017.
