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Mesenchymal stromal cells for the treatment of steroid induced avascular osteonecrosis in children – a two year follow-up


Children with haematological or autoimmune diseases (e.g. lupus erythematodes) are prone to acquire avascular osteonecrosis (AVN) following treatment with high dose steroids. More than 35% of those with advanced AVN stages (Marcus/Enneking II and III) fail to respond solely to core decompression.

Multipotent mesenchymal stromal cells (MSC) are capable of transforming into various mesenchymal tissues, e.g. bone. A combination therapy might be of benefit for those children.


We aim to show that the regeneration process of osseous structures is possible by local MSC application for steroid induced AVN in a child.

Patients and methods

One female patient with leukaemia and steroid induced AVN of the right knee (Marcus Enneking stage II-III) was treated with core decompression and local application of autologous MSC. The healing process was followed by MRI and CT-scan over a two year period.


No early or late adverse events occurred. Two weeks after the procedure our patient was pain-free. Follow-up MRIs on day +72 and +210 showed a slow regress of the initial bone marrow edema and a continuing regeneration of the osseous defect. The CT-scan 24 months later documented the re-ossification of the initial lesion.


Local MSC-application might be a promising treatment option for advanced steroid induced AVN in children with haematological or autoimmune diseases. Results of a prospective study are under preparation.


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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Tzaribachev, N., Vaegler, M., Schaefer, A. et al. Mesenchymal stromal cells for the treatment of steroid induced avascular osteonecrosis in children – a two year follow-up. Pediatr Rheumatol 6 (Suppl 1), P147 (2008).

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