Purpose
To histologically evaluate the quality of articular cartilage regeneration from the
medial compartment after arthroscopic subchondral drilling followed by postoperative
intra-articular injections of autologous peripheral blood stem cells (PBSCs) and hyaluronic
acid with concomitant medial open-wedge high tibial osteotomy (HTO) in patients with
varus deformity of the knee joint.
Methods
Eight patients with varus deformity of the knee joint underwent arthroscopic subchondral
drilling of International Cartilage Repair Society (ICRS) grade 4 bone-on-bone lesions
of the medial compartment with concomitant HTO. These patients were part of a larger
pilot study in which 18 patients underwent the same procedure. PBSCs were harvested
and cryopreserved preoperatively. At 1 week after surgery, 8 mL of PBSCs was mixed
with 2 mL of hyaluronic acid and injected intra-articularly into the knee joint; this
was repeated once a week for 5 consecutive weeks. Three additional intra-articular
injections were administered weekly at intervals of 6, 12, and 18 months postoperatively.
Informed consent was obtained at the time of hardware removal for opportunistic second-look
arthroscopy and chondral biopsy. Biopsy specimens were stained with H&E, safranin
O, and immunohistochemical staining for type I and II collagen. Specimens were graded
using the 14 components of the ICRS Visual Assessment Scale II, and a total score
was obtained.
Results
Second-look arthroscopy showed satisfactory healing of the regenerated cartilage.
Histologic analysis showed significant amounts of proteoglycan and type II collagen.
The total ICRS Visual Assessment Scale II histologic scores comparing the regenerated
articular cartilage (mean, 1,274) with normal articular cartilage (mean, 1,340) indicated
that the repair cartilage score approached 95% of the normal articular cartilage score.
There were no infections, delayed unions, or nonunions.
Conclusions
Chondrogenesis with stem cells in combination with medial open-wedge HTO for varus
deformity correction of the knee joint regenerates cartilage that closely resembles
the native articular cartilage.
Level of Evidence
Level IV, therapeutic case series.
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Article info
Publication history
Published online: May 22, 2015
Accepted:
March 19,
2015
Received:
October 14,
2014
Footnotes
The authors report that they have no conflicts of interest in the authorship and publication of this article.
Identification
Copyright
© 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
