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).
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.
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).
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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- Proximal tibial osteotomy: A critical long-term study of eighty-seven cases.J Bone Joint Surg Am. 1993; 75: 196-201
- Fixation stability of opening- versus closing-wedge high tibial osteotomy: A randomised clinical trial using radiostereometry.J Bone Joint Surg Br. 2009; 91: 1459-1465
- Does arthroscopic abrasion arthroplasty promote cartilage regeneration in osteoarthritic knees with eburnation? A prospective study of high tibial osteotomy with abrasion arthroplasty versus high tibial osteotomy alone.Arthroscopy. 1997; 13: 9-17
- Histologic and immunohistochemical characteristics of failed articular cartilage resurfacing procedures for osteochondritis of the knee: A case series.Am J Sports Med. 2008; 36: 360-368
- The microfracture technique for the treatment of articular cartilage lesions in the knee. A prospective cohort study.J Bone Joint Surg Am. 2005; 87: 1911-1920
- Human autologous culture expanded bone marrow mesenchymal cell transplantation for repair of cartilage defects in osteoarthritic knees.Osteoarthritis Cartilage. 2002; 10: 199-206
- Evaluation of intraarticular mesenchymal stem cells to augment healing of microfractured chondral defects.Arthroscopy. 2011; 27: 1552-1561
- Evaluation of cartilage injuries and repair.J Bone Joint Surg Am. 2003; 85: 58-69
- Microfracture: Surgical technique and rehabilitation to treat chondral defects.Clin Orthop Relat Res. 2001; 391: S362-S369
- The survey on cellular and engineered tissue therapies in Europe in 2010.Tissue Eng Part A. 2012; 18: 2268-2279
- Identification of stromal cell precursors in human bone marrow by a novel monoclonal antibody, STRO-1.Blood. 1991; 78: 55-62
- Minimal criteria for defining multipotent mesenchymal stromal cells. The International Society for Cellular Therapy position statement.Cytotherapy. 2006; 8: 315-317
- Definition of pertinent parameters for the evaluation of articular cartilage repair tissue with high-resolution magnetic resonance imaging.Eur J Radiol. 2004; 52: 310-319
- Increased knee cartilage volume in degenerative joint disease using percutaneously implanted, autologous mesenchymal stem cells.Pain Physician. 2008; 11: 343-353
- Injectable mesenchymal stem cell therapy for large cartilage defects—A porcine model.Stem Cells. 2007; 25: 2964-2971
- Autologous bone marrow-derived mesenchymal stem cells versus autologous chondrocyte implantation: An observational cohort study.Am J Sports Med. 2010; 38: 1110-1116
- Direct transplantation of mesenchymal stem cells into the knee joints of Hartley strain guinea pigs with spontaneous osteoarthritis.Arthritis Res Ther. 2012; 14: R31
- Articular cartilage regeneration with autologous marrow aspirate and hyaluronic acid: An experimental study in a goat model.Arthroscopy. 2009; 25: 1391-1400
- Mobilization of bone marrow-derived mesenchymal stem cells into the injured tissues after intraarticular injection and their contribution to tissue regeneration.Knee Surg Sports Traumatol Arthrosc. 2006; 14: 1307-1314
- Local adherent technique for transplanting mesenchymal stem cells as a potential treatment of cartilage defect.Arthritis Res Ther. 2008; 10: R84
- Chondral resurfacing and high tibial osteotomy in the varus knee: Survivorship analysis.Am J Sports Med. 2010; 38: 1420-1424
- Patient satisfaction after medial opening high tibial osteotomy and microfracture.J Knee Surg. 2007; 20: 129-133
- Activity levels are higher after osteochondral autograft transfer mosaicplasty than after microfracture for articular cartilage defects of the knee: A retrospective comparative study.J Bone Joint Surg Am. 2012; 94: 971-978
- Fibrocartilage following microfracture is not as robust as native articular cartilage: Commentary on an article by Aaron J. Krych, MD, et al.: “Activity levels are higher after osteochondral autograft transfer mosaicplasty than after microfracture for articular cartilage defects of the knee. A retrospective comparative study.”.J Bone Joint Surg Am. 2012; 94: e80
- A novel cell delivery system using magnetically labeled mesenchymal stem cells and an external magnetic device for clinical cartilage repair.Arthroscopy. 2008; 24: 69-76
- Augmentation of degenerated human cartilage in vitro using magnetically labeled mesenchymal stem cells and an external magnetic device.Arthroscopy. 2009; 25: 1435-1441
- Articular cartilage repair using an intra-articular magnet and synovium-derived cells.J Orthop Res. 2011; 29: 531-538
Accepted: September 18, 2013
Received: May 8, 2013
The authors report that they have no conflicts of interest in the authorship and publication of this article.
© 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.