Co-administration of Umbilical Cord Mesenchymal Stem Cell Secretome and Intra-articular Dextrose Prolotherapy in Knee Osteoarthritis with Joint Effusion: A Case Report

Abstract

Introduction

Knee osteoarthritis affects 7.8 million people in Indonesia. Since 1990, the number of osteoarthritis cases in Indonesia has more than doubled. A proportion of patients derive inadequate benefit from pharmacological therapy and from conventional intra-articular injections. Umbilical cord mesenchymal stem cell (UC-MSC) secretome and dextrose prolotherapy are two injectable modalities with distinct mechanisms of action, yet their concurrent administration has never been reported, still less in a knee complicated by joint effusion.

Case Presentation

A 49-year-old woman with right knee pain of one year's duration, a body mass index of 33.8 kg/m², radiographic features consistent with Kellgren–Lawrence grade 1, and an effusion demonstrated on ultrasonography. The visual analogue scale (VAS) score was 6/10 and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score 57/96. Previous therapy comprising nonsteroidal anti-inflammatory drugs, hyaluronic acid, and intra-articular corticosteroid had conferred no meaningful improvement. The patient underwent three ultrasound-guided sessions at three-week intervals, each consisting of synovial fluid aspiration when an effusion was present, followed by injection of 1.5 mL UC-MSC secretome and 2 mL of 20% dextrose intra-articularly, and 2 mL of 12.5% dextrose peri-articularly.

Results

At week six, the VAS score had fallen to 1/10 and the WOMAC score to 3/96, both exceeding the minimal clinically important difference. The volume of aspirated fluid decreased from 8 mL to 3 mL, and at the week-six assessment the effusion was no longer demonstrable on ultrasonography. The patient regained the ability to stand for prolonged periods without pain and to perform prayer in the standard posture, including sitting with maximal knee flexion. Adverse effects were confined to mild injection-site pain.

Conclusion

Co-administration of UC-MSC secretome and dextrose prolotherapy in knee osteoarthritis with effusion was accompanied by substantial improvement in pain and function and by resolution of the effusion within six weeks, without significant adverse effects. As a single case report, causality cannot be established and the contribution of each individual modality cannot be disentangled.