Purpose
To provide a systematic review of the clinical literature reporting the efficacy of
mesenchymal stem cells (MSCs) in terms of clinical outcomes including pain and function
and cartilage repair in patients with osteoarthritis.
Methods
We systematically reviewed any studies investigating clinical outcomes and cartilage
repair after the clinical application of cell populations containing MSCs in human
subjects with knee osteoarthritis through MEDLINE, EMBASE, the Cochrane Library, CINAHL,
Web of Science, and Scopus. Preferred Reporting Items for Systematic Reviews and Meta-Analyses
guidelines were followed. Studies with a level of evidence of IV or V were excluded.
Methodological quality was assessed using the Modified Coleman Methodology Score.
Clinical outcomes were assessed using clinical scores, and cartilage repair was assessed
using magnetic resonance imaging and second-look arthroscopy findings.
Results
A total of 17 studies that met the criteria of 50 full-text studies were included
in this review, with 6 randomized controlled trials, 8 prospective observational studies,
and 3 retrospective case-control studies. Among 17 studies, 8 studies used bone marrow–derived
MSCs, 6 used adipose tissue–derived stromal vascular fraction, 2 used adipose tissue–derived
MSCs, and 1 used umbilical cord blood–derived MSCs. All studies except 2 reported
significantly better clinical outcomes in the MSC group or improved clinical outcomes
at final follow-up. In terms of cartilage repair, 9 of 11 studies reported improvement
of the cartilage state on magnetic resonance imaging, and 6 of 7 studies reported
repaired tissue on second-look arthroscopy. The mean Modified Coleman Methodology
Score was 55.5 ± 15.5 (range, 28-74).
Conclusions
Intra-articular MSCs provide improvements in pain and function in knee osteoarthritis
at short-term follow-up (<28 months) in many cases. Some efficacy has been shown of
MSCs for cartilage repair in osteoarthritis; however, the evidence of efficacy of
intra-articular MSCs on both clinical outcomes and cartilage repair remains limited.
Level of Evidence
Level III; systematic review of level I, II, and III studies.
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Article Info
Publication History
Published online: November 16, 2018
Accepted:
July 12,
2018
Received:
January 31,
2018
Footnotes
See commentary on page 289
The authors report the following potential conflicts of interest or sources of funding: This study was supported by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute, funded by the Ministry of Health & Welfare,Republic of Korea (grant no. HI14C3484 ). The funding sources were not involved in the study design, collection, analysis or interpretation of the data, writing of the manuscript, or in the decision to submit the manuscript for publication. This study was performed at Chung-Ang University Hospital. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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