Cell‐based therapy injections for the management of knee osteoarthritis: The ESSKA–ICRS consensus. Recommendations using the RAND/UCLA appropriateness method for different clinical scenarios

Abstract Purpose The aim of this consensus was to develop evidence/expert‐based patient‐focused recommendations on the appropriateness of intra‐articular point‐of‐care (POC) cell‐based therapy (CBT) injections in different clinical scenarios of patients with knee osteoarthritis (OA). Methods The RAND/UCLA Appropriateness Method was used by European experts of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) and the International Cartilage Regeneration and Joint Preservation Society (ICRS) to reach a consensus and produce recommendations for specific patient categories, combining best available scientific evidence with the collective judgement of a panel of experts. Results A total of 144 scenarios were developed based on five factors: cell source (bone marrow vs. adipose tissue), age (<50 vs. 50–65 vs. 66–80 vs. >80 years), joint involvement (prevalent tibio‐femoral vs. patello‐femoral), OA level (Kellgren–Lawrence [KL] Grade 0–I vs. II–III vs. IV) and body mass index (BMI) (<18.5 vs. 18.5–35 vs. >35 kg/m 2 ). Following two voting rounds, agreement was reached for all 144 (100%) scenarios: the indication was considered appropriate in 11.8%, inappropriate in 34.7% and uncertain in 53.5%. The parameters with the highest appropriateness were OA Grade II–III (35.4% appropriate scenarios), age <50 years (22.2% appropriate) and BMI 18.5–35 kg/m 2 (20.8% appropriate). The parameters with the highest inappropriateness were age >80 years (88.9% inappropriate), OA grade IV (62.5% inappropriate) and BMI > 35 kg/m 2 (50.0% inappropriate). Conclusions This ESSKA–ICRS expert consensus provides recommendations on the appropriateness of cell‐based injectable therapies for knee OA. POC‐CBT may be considered, after failure of other non‐operative and injectable options, in patients aged ≤65 years with BMI ≤ 35 kg/m 2 and KL Grade II–III OA. Unlike bone marrow–derived CBT, adipose‐derived CBT was also considered appropriate in patients 66–80 years old with BMI 18.5–35 kg/m 2 and KL Grade II–III OA. On the other hand, CBT was considered inappropriate in patients over 80 years old and in those with KL Grade IV OA. These findings may help improve patient selection, although they should not be interpreted as a rigid treatment algorithm but rather as expert‐informed guidance for the use of POC‐CBT in knee OA. Level of Evidence Level I.

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Journal
Knee Surgery Sports Traumatology Arthroscopy
Published
2026-06-26
DOI
https://doi.org/10.1002/ksa.70487
Primary Topic
Mesenchymal stem cell research
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article
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article

Cell‐based therapy injections for the management of knee osteoarthritis: The ESSKA–ICRS consensus. Recommendations using the RAND/UCLA appropriateness method for different clinical scenarios

Rodica Marinescu, Kristof Sas, M Á Sánchez, Elizaveta Kon et al.
Knee Surgery Sports Traumatology Arthroscopy
Mesenchymal stem cell research
article

Cell‐based therapy injections for the management of knee osteoarthritis: The ESSKA–ICRS consensus. Recommendations using the RAND/UCLA appropriateness method for different clinical scenarios

Rodica Marinescu, Kristof Sas, M Á Sánchez, Elizaveta Kon, Stefan Nehrer, Francesca de, Matej Drobnič, Tobias Winkler, Jasmin Bagge, Konrad Słynarski, Kristoffer Weisskirchner Barfod, Alessandro Di Martino, Lior Laver, Luca Andriolo, Angelo Boffa, Laura Mangiavini, George Skarpas, Giuseppe Filardo, Ricardo Bastos, Martyn Snow, Ramón Cugat, Lucienne Vonk, Marko Ostojić, Jérémy Magalon, Baris Kocaoglu, Thomas Tischer, João Espregueira‐Mendes, Laura de Girolamo, Michael Iosifidis
article en

Abstract

Abstract Purpose The aim of this consensus was to develop evidence/expert‐based patient‐focused recommendations on the appropriateness of intra‐articular point‐of‐care (POC) cell‐based therapy (CBT) injections in different clinical scenarios of patients with knee osteoarthritis (OA). Methods The RAND/UCLA Appropriateness Method was used by European experts of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) and the International Cartilage Regeneration and Joint Preservation Society (ICRS) to reach a consensus and produce recommendations for specific patient categories, combining best available scientific evidence with the collective judgement of a panel of experts. Results A total of 144 scenarios were developed based on five factors: cell source (bone marrow vs. adipose tissue), age (<50 vs. 50–65 vs. 66–80 vs. >80 years), joint involvement (prevalent tibio‐femoral vs. patello‐femoral), OA level (Kellgren–Lawrence [KL] Grade 0–I vs. II–III vs. IV) and body mass index (BMI) (<18.5 vs. 18.5–35 vs. >35 kg/m 2 ). Following two voting rounds, agreement was reached for all 144 (100%) scenarios: the indication was considered appropriate in 11.8%, inappropriate in 34.7% and uncertain in 53.5%. The parameters with the highest appropriateness were OA Grade II–III (35.4% appropriate scenarios), age <50 years (22.2% appropriate) and BMI 18.5–35 kg/m 2 (20.8% appropriate). The parameters with the highest inappropriateness were age >80 years (88.9% inappropriate), OA grade IV (62.5% inappropriate) and BMI > 35 kg/m 2 (50.0% inappropriate). Conclusions This ESSKA–ICRS expert consensus provides recommendations on the appropriateness of cell‐based injectable therapies for knee OA. POC‐CBT may be considered, after failure of other non‐operative and injectable options, in patients aged ≤65 years with BMI ≤ 35 kg/m 2 and KL Grade II–III OA. Unlike bone marrow–derived CBT, adipose‐derived CBT was also considered appropriate in patients 66–80 years old with BMI 18.5–35 kg/m 2 and KL Grade II–III OA. On the other hand, CBT was considered inappropriate in patients over 80 years old and in those with KL Grade IV OA. These findings may help improve patient selection, although they should not be interpreted as a rigid treatment algorithm but rather as expert‐informed guidance for the use of POC‐CBT in knee OA. Level of Evidence Level I.

Knee Surgery Sports Traumatology Arthroscopy
Universität für Weiterbildung Krems (AT), Humanitas University (IT), University of Mostar (BA), Inserm (FR), Universidade Federal Fluminense (BR), Carol Davila University of Medicine and Pharmacy (RO), University of Nicosia (CY), Technion – Israel Institute of Technology (IL), University of Milan (IT), Aix-Marseille Université (FR), University of Pavia (IT), University Clinical Hospital Mostar (BA), Amager Hospital (DK), Frederiksberg Hospital (DK), Interbalkan Medical Center (GR), Ljubljana University Medical Centre (SI), Hillel Yaffe Medical Center (IL), Royal Orthopaedic Hospital (GB), Hvidovre Hospital (DK), Erasmus Hospital (BE), Copenhagen University Hospital (DK), University Medical Center Utrecht (NL), Acıbadem University (TR), Humboldt-Universität zu Berlin (DE), Arttic (IL), Hôpital de la Conception (FR), Mercy University Hospital (IE), Istituto Clinico Sant'Ambrogio (IT), Hellenic Agency for Local Development and Local Government (GR), Malteser Waldkrankenhaus Erlangen (DE), Hospital Quirónsalud Barcelona (ES), Rappaport Family Institute for Research in the Medical Sciences (IL), Province of Antwerp (BE), Universitätsklinikum Krems (AT), Istituto Ortopedico Rizzoli (IT), Unidad de Cirugía Artroscópica (ES), Centro Hospitalar do Tâmega e Sousa (PT), Mirai Hospital (JP), Mitera Hospital (GR), FC Barcelona (ES), Berlin Institute of Health at Charité - Universitätsmedizin Berlin (DE), Centrallasarettet Växjö (SE), Casa di Cura Città di Roma (IT), Azienda di Servizi alla Persona di Pavia (Italy) (IT), Spitalul Clinic Colentina (RO), IRCCS Humanitas Research Hospital (IT), University of Rostock (DE), Keele University (GB), Università della Svizzera italiana (CH), University of Minho (PT)
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Mesenchymal stem cell research
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