Human umbilical cord-blood-derived mesenchymal stem cell can improve the clinical outcome and Joint space width after high tibial osteotomy

Suh, Dong Won; Han, Seung Beom; Yeo, Woo Jin; Cheong, Kuhoang; S, So; Kyung, Bong Soo

doi:10.1016/j.knee.2021.08.028

Cited by 13 publications

(32 citation statements)

References 34 publications

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“…The mean CMS was 81.17 ± 4.45 ( Table 2 ). Four of 6 studies were of good methodological quality, 21 , 34 , 36 , 38 while the other 2 studies were of excellent methodological quality. 19 , 20 …”

Section: Resultsmentioning

confidence: 97%

“…One of 6 studies used bone marrow–derived MSCs, 36 while the other studies were performed with human umbilical cord blood–derived MSCs 21 , 34 , 38 and adipose-derived MSCs. 19 , 20 Three studies used allogenic MSCs, 21 , 34 , 38 and the other 3 studies used autologous MSCs. 19 , 20 , 36 Detailed characteristics of included studies are summarized in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

“…The Lysholm score was reported in 3 studies with 244 patients (MSCs, n = 114; control, n = 130). 19 , 20 , 34 One study reported Lysholm score at second-look arthroscopic surgery and the final follow-up, 19 and the other 2 studies only reported the Lysholm score at the final follow-up. 20 , 34 The Lysholm score in the MSC treatment group was significantly increased (mean difference [MD], 2.55; 95% CI, 0.70-4.40; P = .007) as compared with the control group, with low heterogeneity between studies ( I 2 = 0%) ( Figure 2A ).…”

Section: Resultsmentioning

confidence: 99%

“…The IKDC score was reported in 3 studies with 310 patients (MSCs, n =148; control, n = 162). 19 , 34 , 38 One study reported the IKDC score at second-look arthroscopic surgery and the final follow-up, 19 and the other 2 studies only reported them at the final follow-up. 34 , 38 Treatment with MSCs led to an increase in IKDC score, with high heterogeneity ( I 2 = 78%), although it was not statistically significant (MD, 4.81; 95% CI, –0.23 to 9.84; P = .06) ( Figure 2B ).…”

Section: Resultsmentioning

confidence: 99%

“…Therefore, additional cartilage repair procedures were suggested to enhance the outcomes of HTO. 19 – 21 , 34 …”

mentioning

confidence: 99%

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Intra-articular Injection of Mesenchymal Stem Cells After High Tibial Osteotomy: A Systematic Review and Meta-analysis

Jin

Yang

Men

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: Multiple studies have investigated the use of mesenchymal stem cells (MSCs) for patients undergoing high tibial osteotomy (HTO), and the effectiveness thereof remains controversial. Purpose: To analyze the effectiveness of intra-articular MSC injection in patients who underwent HTO in terms of clinical outcomes, radiological outcomes, and cartilage repair by a meta-analysis of the available literature. Study Design: Systematic review; Level of evidence, 3. Methods: The electronic databases of PubMed, Embase, Web of Science, and the Cochrane Library were searched from their inception to October 30, 2021, for comparative studies between patients who underwent HTO with and without intra-articular injection of MSCs, according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Study quality was assessed by the Coleman Methodology Score (CMS). Data with comparable results were pooled for meta-analysis. The primary outcomes of interest were the Hospital for Special Surgery (HSS), International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), and Lysholm scores, as well as the International Cartilage Regeneration & Joint Preservation Society (ICRS) grade of cartilage repair. Radiological outcomes including femorotibial angle, posterior tibial slope, and hip-knee-ankle (HKA) angle were included as secondary outcomes. A fixed-model effect was used for meta-analyses with low heterogeneity between studies ( I 2 < 25%), while the random-model effect was used for medium- to high-heterogeneity analyses ( I 2 ≥ 25%). Results: A total of 843 studies were screened, of which 6 studies with 452 patients met the inclusion criteria and were included. The mean CMS was 81.17. Patients with MSC injection had significantly higher Lysholm scores ( P = .007) and HSS scores ( P = .01) and higher proportions of ICRS grade 1 ( P = .03) and grade 2 ( P = .02) cartilage repair in the medial femoral condyle and grade 2 cartilage repair in the tibial plateau ( P = .04). There were no significant differences between groups in the IKDC score, KOOS Pain and Symptoms subscales, femorotibial angle, posterior tibial slope, or HKA angle. Conclusion: Intra-articular MSC injection may enhance the cartilage repair for patients who undergo HTO. However, evidence of improvement in knee functions remains limited. Registration: CRD42021291345 (PROSPERO).

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Section: Resultsmentioning

confidence: 97%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…Therefore, additional cartilage repair procedures were suggested to enhance the outcomes of HTO. 19 – 21 , 34 …”

mentioning

confidence: 99%

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Intra-articular Injection of Mesenchymal Stem Cells After High Tibial Osteotomy: A Systematic Review and Meta-analysis

Jin

Yang

Men

et al. 2022

Orthopaedic Journal of Sports Medicine

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Implantation of hUCB‐MSCs generates greater hyaline‐type cartilage than microdrilling combined with high tibial osteotomy

Jung,

Park,

Jung

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeTo compare the outcomes of treating large cartilage defects in knee osteoarthritis using human allogeneic umbilical cord blood‐derived mesenchymal stem cell (hUCB‐MSC) implantation or arthroscopic microdrilling as a supplementary cartilage regenerative procedure combined with high tibial osteotomy (HTO).MethodsThis 1‐year prospective comparative study included 25 patients with large, near full‐thickness cartilage defects (International Cartilage Repair Society grade ≥ IIIB) in the medial femoral condyles and varus malalignment. Defects were treated with hUCB‐MSC implantation or arthroscopic microdrilling combined with HTO. The primary outcomes were pain visual analogue scale and International Knee Documentation Committee subjective scores at 12, 24 and 48 weeks. Secondary outcomes included arthroscopic, histological and magnetic resonance imaging assessments at 1 year.ResultsFifteen and 10 patients were treated via hUCB‐MSC implantation and microdrilling, respectively. Baseline demographics, limb alignment and clinical outcomes did not significantly differ between the groups. Cartilage defects and total restored areas were significantly larger in the hUCB‐MSC group (7.2 ± 1.9 vs. 5.2 ± 2.1 cm2, p = 0.023; 4.5 ± 1.4 vs. 3.0 ± 1.6 cm2, p = 0.035). The proportion of moderate‐to‐strong positive type II collagen staining was significantly higher in the hUCB‐MSC group compared to that in the microdrilled group (93.3% vs. 60%, respectively). Rigidity upon probing resembled that of normal cartilage tissue more in the hUCB‐MSC group (86.7% vs. 50.0%, p = 0.075). Histological findings revealed a higher proportion of hyaline cartilage in the group with implanted hUCB‐MSC (p = 0.041).ConclusionhUCB‐MSC implantation showed comparable clinical outcomes to those of microdrilling as supplementary cartilage procedures combined with HTO in the short term, despite the significantly larger cartilage defect in the hUCB‐MSC group. The repaired cartilage after hUCB‐MSC implantation showed greater hyaline‐type cartilage with rigidity than that after microdrilling.Level of EvidenceLevel II, Prospective Comparative Cohort Study.

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Biological intra‐articular augmentation for osteotomy in knee osteoarthritis: strategies and results

Reale

Feltri²,

Franceschini

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose To assess whether there is evidence supporting the use of augmentation strategies, either cartilage surgical procedures or injective orthobiologic options, to improve the results of osteotomies in knees with osteoarthritis (OA). Methods A systematic review of the literature was performed on the PubMed, Web of Science and the Cochrane databases in January 2023 on osteotomies around the knee associated with augmentation strategies (either cartilage surgical procedures or injective orthobiologic options), reporting clinical, radiological, or second‐look/histological outcomes at any follow‐up. The methodological quality of the included studies was assessed with the Coleman Methodology Score (CMS). Results Out of the 7650 records identified from the databases, 42 articles were included for a total of 3580 patients and 3609 knees treated; 33 articles focused on surgical treatments and 9 on injective treatments performed in association with knee osteotomy. Out of the 17 comparative studies with surgical augmentation, only 1 showed a significant clinical benefit of an augmentation procedure with a regenerative approach. Overall, other studies showed no differences with reparative techniques and even detrimental outcomes with microfractures. Regarding injective procedures, viscosupplementation showed no improvement, while the use of platelet‐rich plasma or cell‐based products derived from both bone marrow and adipose tissue showed overall positive tissue changes which translated into a clinical benefit. The mean modified CMS score was 60.0 ± 12.1. Conclusion There is no evidence to support the effectiveness of cartilage surgical treatments combined with osteotomies in terms of pain relief and functional recovery of patients affected by OA in misaligned joints. Orthobiologic injective treatments targeting the whole joint environment showed promising findings. However, overall the available literature presents a limited quality with only few heterogeneous studies investigating each treatment option. This ORBIT systematic analysis will help surgeons to choose their therapeutic strategy according to the available evidence, and to plan further and better studies to optimize biologic intra‐articular osteotomy augmentation. Level of evidence Level IV.

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Human umbilical cord-blood-derived mesenchymal stem cell can improve the clinical outcome and Joint space width after high tibial osteotomy

Cited by 13 publications

References 34 publications

Intra-articular Injection of Mesenchymal Stem Cells After High Tibial Osteotomy: A Systematic Review and Meta-analysis

Intra-articular Injection of Mesenchymal Stem Cells After High Tibial Osteotomy: A Systematic Review and Meta-analysis

Implantation of hUCB‐MSCs generates greater hyaline‐type cartilage than microdrilling combined with high tibial osteotomy

Biological intra‐articular augmentation for osteotomy in knee osteoarthritis: strategies and results

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