Implantation of mesenchymal stem cells in combination with allogenic cartilage improves cartilage regeneration and clinical outcomes in patients with concomitant high tibial osteotomy

Abstract

Purpose This study aimed to compare the clinical, radiological, and second‐look arthroscopic outcomes of implanting mesenchymal stem cells (MSCs) alone and together with allogenic cartilage in patients treated with concomitant high tibial oteotomy (HTO) for varus knee osteoarthritis. Methods Eighty patients treated with cartilage repair procedures and concomitant HTO were prospectively randomized into two groups: MSC implantation (MSC group), and MSC implantation with allogenic cartilage (MSC‐AC group). Clinical outcomes were evaluated using the Lysholm Score and the Knee Injury and Osteoarthritis Outcome Score (KOOS) at preoperative and every follow‐up visit. Radiological outcomes were evaluated by measuring the femorotibial angle and posterior tibial slope. During second‐look arthroscopy, cartilage regeneration was evaluated according to the Kanamiya grade. Results Clinical outcomes at the second‐look arthroscopy (mean 12.5 months [MSC group] and 12.4 months [MSC‐AC group]) improved significantly in both groups (P < 0.001 for all). Clinical outcomes from the second‐look arthroscopy to the final follow‐up (mean 27.3 months [MSC group] and 27.8 months [MSC‐AC group]) improved further only in the MSC‐AC group (P < 0.05 for all). Overall, the Kanamiya grades, which were significantly correlated with clinical outcomes, were significantly higher in the MSC‐AC group than in the MSC group. Radiological outcomes at final follow‐up revealed improved knee joint alignments relative to preoperative conditions but without significant correlation between clinical outcomes and Kanamiya grade in either group (n.s. for all). Conclusion Implantation of MSCs with allogenic cartilage is superior to implantation of MSCs alone in cartilage regeneration accompanied with better clinical outcomes. Level of evidence Therapeutic study, level II.

Mesenchymal Stromal Cell-Based Therapy—An Alternative to Arthroplasty for the Treatment of Osteoarthritis? A State of the Art Review of Clinical Trials

“…In this review we identified six randomized, double-blinded, placebo-controlled trials, including one follow-up study [64][65][66]78,105,109], eight randomized controlled trials [67][68][69]79,[81][82][83]103] and two prospective, randomized cohort studies [70,84]. Most studies were however prospective uncontrolled clinical trials, comparative matched pair analyses, retrospective comparative studies or retrospective case series and an inter-study comparison was difficult due to the variance in study design.…”

“…Local application was either achieved through simple intra-articular injections of MSCs mixed with saline [64,66,99,103,104,110] or PRP [69,70,81,87,89,93,96,97]. Implantation of MSCs was further supported by allogenic cartilage [84], or the use of fibrin glue scaffolds [85,91,94]. Park et al used drill holes [104] and other groups combined MSC applications with surgical correction operations like HTO for knee OA [81,84,86] or lateral sliding calcaneal osteotomy for ankle OA [88].…”

“…Implantation of MSCs was further supported by allogenic cartilage [84], or the use of fibrin glue scaffolds [85,91,94]. Park et al used drill holes [104] and other groups combined MSC applications with surgical correction operations like HTO for knee OA [81,84,86] or lateral sliding calcaneal osteotomy for ankle OA [88].…”

“…A total number of 42 clinical studies including 1325 OA patients were evaluated regarding study type, methods, techniques and outcome measures. The majority of studies focused on OA of the knee [ 63 , 64 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 ], while two studies treated OA of the hip and ankle [ 73 , 88 ]. This may be due to the fact that knee OA has a high prevalence amongst all forms of OA with an estimated lifetime risk of symptomatic manifestation of 40% in men and 47% in women [ 106 , 107 ] and a rather safe and well-described protocol for intra-articular knee-injections [ 108 ].…”

“…To quantify newly-formed cartilage following MSC-based therapies, MRI studies [ 67 , 72 , 74 , 79 , 80 , 82 , 83 , 97 , 103 , 105 , 114 ] or second-look arthroscopy interventions [ 81 , 84 , 85 , 86 , 88 , 89 , 92 , 93 , 99 , 100 , 104 ] can be performed to analyse structural improvements through MSC-based treatment.…”