The article describes two potential treatments for knee problems: using stem cells donated from bone marrow to re-grow cartilage pads and using cartilage plugs, approved for use in bone, to fill in gaps in cartilage. The story does a good job of describing the evidence (either an ongoing clinical trial using stem cells to re-grow cartilage pads or the fact that cartilage plugs are an “off-label” use of an existing technology), although there are limitations to what we know or will know, which could have been clearer. For example, although the first-ever clinical trial of stem cells is ongoing, the number of participants is small and more studies will be needed before this would become widely available. The description of harms of either of these approaches could have been improved. For instance, letting a quote by the lead researcher (who has a conflict of interest) stand stating that there are no safety problems with the stem cell technique is a bit misleading. It’s hard to believe there would be no side effects at all and the fact that this is new technology and that harms may not be known is different than they don’t exist, which is implied. Yet the topic is an important one because better treatments for age-related arthritis of the knee are needed. Unfortunately, the techniques discussed in this article are only precursors of the types of treatments that may help the large number of older individuals suffering from knee arthritis. Even if these treatments provide benefit and are approved for use by the FDA, it will require future studies and many more years to bring successful treatments to the average patient.
Costs of either new treatment approach are not discussed, nor whether they might be covered by insurance.
Since the first-ever clinical trial of stem cells to regrow cartilage pads is ongoing, benefits cannot be quantified. A similar challenge in reporting benefits of cartilage plugs is that this approach doesn’t appear to have any studies that support its use in cartilage (vs. bone), since this is an off-label use. While benefits aren’t reported, it doesn’t appear that there are any to actually describe just yet.
The stem cell technique is quoted by the lead researcher as having “no safety problems.” While this is suspect, since this is the first clinical trial, side effects or harms in humans may not be known. The article could have countered this quote with a statement that no side effects have been reported yet, which is different than that they don’t exist. A potential harm talked about by someone not apparently involved in the research is that too much cartilage may be re-grown and there may not be a mechanism to turn it off, leading to unforeseen problems. For the cartilage plugs, harms of treatment are not discussed, although a question about their benefit–whether they even work in cartilage–is raised.
The story describes on-going research using stem cells to re-grow the cartilage pad, or meniscus, in the knee. The ongoing research is described as a clinical trial, with either a “dummy” or active injection given to patients (so there is a placebo or control group and this also implies patients don’t know which one they’ve received, or that they’re “blinded” to the intervention), and that researchers are blinded to which intervention patients have received. What’s described is a randomized, controlled trial, which is the gold-standard in research. The other technique–cartilage plugs–is being used for treatment that doesn’t appear to have any research to support it, or at least not when used in cartilage (vs. bones). But, the article describes these circumstances to readers.
The article provides a brief overview of knee injury or disease (arthritis) and the numbers of people who experience this. The article nicely states that the “holy grail” is repairing the cartilage of knee bones associated with arthritis – typically age-related wear and tear. None of the treatments mentioned are anywhere near this. So for current patients suffering from knee pain due to degenerative arthritis, the options are conservative medicines (like ibuprofen) or knee replacement surgery. This article suggests an intermediate, less invasive approach. The current cartilage repair procedures aren’t thought to work very well (thus the search for new ones). These aren’t the first attempts to repair cartilage. Others have been tried, but generally haven’t offered much benefit to patients.
For the stem cell research, the article does quote a source who is apparently uninvolved with the research. This source provides some balance in noting that it’s not clear whether this works, and specifically, whether this process can be turned off once enough cartilage is re-grown. For cartilage plugs, the same source comments with skepticism over whether these really work.
Currently, the standard treatment option for meniscus tears is surgical removal of jagged edges that don’t heal, which is mentioned in the story. Treatment alternatives for injured or damaged articular cartilage (vs. use of articular plugs) are described and include total knee replacement and surgery to “rough up” the edges to stimulate natural repair. Framing around what these new treatments hope to provide could have been improved, e.g. many of the intermediate procedures talked about in the article are trying to provide an option in the middle of either a very simple approach, like medications, or a pretty aggressive approach, like joint replacement.
There are two treatment options discussed in the article. One uses stem cells from donated bone marrow. This technique is reported as part of the first-ever clinical trial using stem cells to regrow a cartilage pad in the knee, so readers know this option is not available yet outside of this research study. The second treatment approach uses cartilage plugs to fill in gaps or injuries to knee cartilage. The story states these cartilage plugs are FDA-approved for use in bones, but not cartilage, so the use described is “off-label.”
The article describes the stem cell option as new, which does appear to be true. It also describes the off-label use of cartilage plugs, implying this technique itself may not be new, but is being used in a new capacity. There have been prior attempts to repair cartilage that are not mentioned in the article, but these attempts have not provided much benefit.
There is no obvious reliance on press release material.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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