Study Design: Meta-analysis. Objectives: We aimed to analyze the impact of cultured expansion of autologous mesenchymal stromal cells (MSCs) in the management of osteoarthritis of the knee from randomized controlled trials (RCTs) available in the literature. Materials and Methods: We conducted independent and duplicate electronic database searches including PubMed, Embase, Web of Science, and Cochrane Library until August 2021 for RCTs analyzing the efficacy and safety of culture-expanded compared to non-cultured autologous MSCs in the management of knee osteoarthritis. The Visual Analog Score (VAS) for pain, Western Ontario McMaster University’s Osteoarthritis Index (WOMAC), Lysholm score, Knee Osteoarthritis Outcome Score (KOOS), and adverse events were the analyzed outcomes. Analysis was performed in R-platform using OpenMeta [Analyst] software. Results: Overall, 17 studies involving 767 patients were included for analysis. None of the studies made a direct comparison of the culture expanded and non-cultured MSCs, hence we pooled the results of all the included studies of non-cultured and cultured types of MSC sources and made a comparative analysis of the outcomes. At six months, culture expanded MSCs showed significantly better improvement (p < 0.001) in VAS outcome. Uncultured MSCs, on the other hand, demonstrated significant VAS improvement in the long term (12 months) in VAS (p < 0.001), WOMAC (p = 0.025), KOOS score (p = 0.016) where cultured-expanded MSCs failed to demonstrate a significant change. Culturing of MSCs did not significantly increase the complications noted (p = 0.485). On sub-group analysis, adipose-derived uncultured MSCs outperformed culture-expanded MSCs at both short term (six months) and long term (12 months) in functional outcome parameters such as WOMAC (p < 0.001, p = 0.025), Lysholm (p < 0.006), and KOOS (p < 0.003) scores, respectively, compared to their controls. Conclusions: We identified a void in literature evaluating the impact of culture expansion of MSCs for use in knee osteoarthritis. Our indirect analysis of literature showed that culture expansion of autologous MSCs is not a necessary factor to obtain superior results in the management of knee osteoarthritis. Moreover, while using uncultured autologous MSCs, we recommend MSCs of adipose origin to obtain superior functional outcomes. However, we urge future trials of sufficient quality to validate our findings to arrive at a consensus on the need for culture expansion of MSCs for use in cellular therapy of knee osteoarthritis.

BACKGROUNDIn bicondylar tibial plateau fractures, the most frequently used treatment is ORIF with screws and plates; however, the soft tissue complications are frequently reported. Minimally-invasive Ilizarov technique is an alternative. The purpose of this study was to compare and analyse the clinical and radiological results of locking plate and Ilizarov technique in bicondylar tibial plateau fractures treated at a level I trauma centre. MATERIALS AND METHODSThe patients with closed isolated bicondylar tibial fractures (Schatzker V/VI) were included in the study. Fifteen patients (8 of type V and 7 of type VI) in one group were treated using locked plating system and fifteen patients (5 of type V and 10 of type VI) in another group were treated with Ilizarov technique. Pre-and post-operatively, conventional radiographs, CT scans, hospital stay and complications were evaluated. The outcomes were evaluated using modified Rasmussen clinical and radiological criteria. RESULTSThe two groups were similar demographically. Both the techniques achieved acceptable osseous reduction. When compared with internal fixation, Ilizarov had increased average range of motion (124˚ vs 117˚), decreased complications (p= 0.01), reduced hospital stay (0.001), earlier weight-bearing and marginally faster recovery (outcome in terms of modified Rasmussen clinical assessment score) at 6 months. But the outcomes were not significantly different at 1 year. In this study, Ilizarov technique had slight favourable outcome compared to locked plating group. CONCLUSIONThe Ilizarov method produces a good clinical outcome and is a valuable alternative treatment for bicondylar tibial plateau fractures with added advantage of decreased hospital stay, decreased waiting time for definitive surgery and early weight bearing.

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The author reports on a patient a case of severe metallosis in total knee replacement. Wear of total knee replacement continues to be a significant factor influencing the clinical longevity of implants. Here we present a case of a 63-year-old female who had undergone total knee arthroplasty 15 years ago and developed implant loosening associated with severe metallosis and varus instability the metallic debris leads to a massive local and systemic release of cytokines. This patient was subjected to revision surgery consisting of thorough debridement and primary implant replacement by a hinged endoprosthesis.