Purpose
To analyze the results of the use of intra-articular cultured autologous bone marrow–derived
mesenchymal stem cell (MSC) injections in conjunction with microfracture and medial
opening-wedge high tibial osteotomy (HTO).
Methods
Fifty-six knees in 56 patients with unicompartmental osteoarthritic knees and genu
varum were randomly allocated to the cell-recipient group (n = 28) or control group
(n = 28). Patients who had a joint line congruity angle of more than 2°, malalignment
of the knee from femoral causes, a fixed flexion deformity, or age older than 55 years
were excluded. All patients underwent HTO and microfracture. The cell-recipient group
received intra-articular injection of cultured MSCs with hyaluronic acid 3 weeks after
surgery, whereas the control group only received hyaluronic acid. The primary outcome
measure was the International Knee Documentation Committee (IKDC) score at intervals
of 6 months, 1 year, and 2 years postoperatively. Secondary outcome measures were
Tegner and Lysholm clinical scores and 1-year postoperative Magnetic Resonance Observation
of Cartilage Repair Tissue (MOCART) scores.
Results
The median age of the patients was 51 years, with a mean body mass index of 23.85.
Both treatment arms achieved improvements in Tegner, Lysholm, and IKDC scores. After
adjustment for age, baseline scores, and time of evaluation, the cell-recipient group
showed significantly better scores. The effect of treatment showed an added improvement
of 7.65 (95% confidence interval [CI], 3.04 to 12.26; P = .001) for IKDC scores, 7.61 (95% CI, 1.44 to 13.79; P = .016) for Lysholm scores, and 0.64 (95% CI, 0.10 to 1.19; P = .021) for Tegner scores. Magnetic resonance imaging scans performed 1 year after
surgical intervention showed significantly better MOCART scores for the cell-recipient
group. The age-adjusted mean difference in MOCART score was 19.6 (95% CI, 10.5 to
28.6; P < .001).
Conclusions
Intra-articular injection of cultured MSCs is effective in improving both short-term
clinical and MOCART outcomes in patients undergoing HTO and microfracture for varus
knees with cartilage defects.
Level of Evidence
Level II, randomized controlled trial.
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Article info
Publication history
Accepted:
September 18,
2013
Received:
May 8,
2013
Footnotes
The authors report that they have no conflicts of interest in the authorship and publication of this article.
Identification
Copyright
© 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
