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J Knee Surg. 2019 Jan;32(1):26-36. doi: 10.1055/s-0038-1676370. Epub 2018 Dec 13.

Amniotic Tissue Modulation of Knee Pain-A Focus on Osteoarthritis.

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Section of Cartilage Restoration and Sports Medicine, Department of Orthopaedics, Rush University Medical Center, Chicago, Illinois.
Cartilage Restoration Center, OrthoIndy Hospital, Greenwood, Indiana.
Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana.


The use of intra-articular therapies as sources of growth factors, anti-inflammatory mediators, and medicinal signaling cells for osteoarthritis (OA) is rapidly evolving. Amnion, chorion, amniotic fluid, and the umbilical cord are distinct placental tissues that have been investigated for use in OA. Amniotic membrane (AM) synthesizes a variety of growth factors, cytokines, and vasoactive peptides that modulate inflammation. In addition, they contain amniotic epithelial cells and amniotic mononuclear undifferentiated stromal cells, which have chondrogenic and osteogenic differentiation capacity. AMs are also rich sources of hyaluronic acid and proteoglycans, which could play a role in the potential therapeutic relief of OA. Currently, there are several commercially available formulations of AM that differ based on content as well as how they were preserved. Understanding the processing of amniotic tissue is important because of their distinct mechanical and biologic effects of preservation on AM grafts. To date, there have been two preclinical and only one clinical study on the use of AM for OA, which show promising results. Many high level of evidence clinical trials are currently underway investigating the use of AM of OA. Future basic science and clinical research is warranted to better understand the anti-inflammatory and chondroregenerative properties of amniotic tissue and to determine clinically what amniotic tissue product is most efficacious for symptomatic OA.

[Indexed for MEDLINE]

Conflict of interest statement

C.P.H. reports no conflicts of interest related to the submitted work; he is a paid consultant for ExplORer Surgical, Inc., outside the submitted work. A.B.Y. reports research support from Organogenesis related to the submitted work; he is a paid consultant for JRF Ortho and has received research support from Arthrex, Inc., outside the submitted work. J.F. is a paid consultant for Organogenesis and has also received research support and royalties from there related to the submitted work; he is a paid consultant for Aesculap, Arthrex, Inc., Cartiheal, Ceterix Orthopaedics, Exactech, Moximed, Inc., Samumed, Inc., TRX Orthopedics, Inc., Vericel, ZimmerBiomet, Zipline Medical; he has received research support through 501(c) (3) non-profits from Active Implants, Arthrex, Inc., Ceterix Orthopaedics, Fidia Pharma, Histogenics, Moximed, Inc., Novartis, Inc., Vericel, ZimmerBiomet; royalties from Arthrex, Inc.; and stock/stock options from MedShape, Inc. and OrthoRegenerative Technologies, Inc., outside the submitted work.

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