Mesenchymal Stem Cells Injection Improves Cartilage Regeneration while Performing High Tibial Osteotomy for Knee Osteoarthritis

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Mesenchymal Stem Cells Injection Improves Cartilage Regeneration while Performing High Tibial Osteotomy for Knee Osteoarthritis

According to scientists of Yonsei Sarang Hospital (Orthopaedic Surgery department), mesenchymal stem cells (MSCs) injection is recommended as an additional procedure to be considered while performing high tibial osteotomy (HTO) as it significantly improves degenerated cartilage with better clinical results among patients with knee osteoarthritis (OA). HTO effectively controls knee by repositioning the load line inside the knee joint. On the other hand, MSCs via cell-based tissue engineering system helps to repair articular cartilage of the knee. Now, the question is what happens if both techniques are combined to treat knee OA?

Yong Sang Kim and Yong Gon Koh conducted a cohort study to compare the open-wedge HTO with versus without an MSC injection and to recognize the relationship between cartilage regeneration and HTO outcomes.

The study also involved the determination of a relationship between HTO and cartilage regeneration. A total of 270 patients who went through HTO from September 2009 to April 2014 were selected. A comparative matched-pair analysis based on age, lesion size and sex was conducted between the conventional group (received treat with the only HTO) and injection group (received HTO with MSC injection). The Posterior tibial slope and femorotibial angle were used to measure radiological and Lysholm along with Knee Documentation Committee (IKDC) scores for clinical outcomes. The International Cartilage Repair Society (ICRS) grade was used to measure cartilage regeneration during the second-look arthroscopic surgery.

Both groups exhibited improved mean Lysholm and IKDC scores at the time of second-look arthroscopic surgery (P < .001). The injection group showed an increase in Lysholm and IKDC scores from 55.7 ± 11.9 and 36.5 ± 4.7 to 80.6 ± 15.6 Lysholm and 62.7 ± 14.1 respectively. Further, the conventional group showed 79.6 ± 13.5 Lysholm and 55.2 ± 15.0 IKDC enhanced scores from 56.7 ± 12.2 and 38.4 ± 9.2 respectively. However, at final follow up only the injection group exhibited increased Lysholm (84.7 ± 16.1) and IKDC (64.8 ± 13.4) scores. The conventional and injection group presented a significantly different mean Lysholm and IKDC at the final follow-up (P = .041 and P = .049 respectively). The injection group also exhibited better ICRS scores correlated with clinical outcomes as compared to the conventional group. Patients also showed improved radiological scores at final follow-up but showed no association with ICRS or clinical outcomes (P > .05). The overall findings recommend that the injection of MSC should be considered as an additional procedure while performing HTO.


Am J Sports Med


Original title of the article:

Comparative Matched-Pair Analysis of Open-Wedge High Tibial Osteotomy With Versus Without an Injection of Adipose-Derived Mesenchymal Stem Cells for Varus Knee Osteoarthritis: Clinical and Second-Look Arthroscopic Results


Yong Sang Kim and Yong Gon Koh

Therapeutic, Knee Osteoarthritis, Knee Joints, Cohort Study, Efficacy, IKDC Scores, ICRS Scores, Lysholm Scores
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