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Human umbilical cord blood-derived mesenchymal stem cell implantation for osteoarthritis of the knee

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

This study aimed to investigate the clinical outcomes after human umbilical cord blood-derived mesenchymal stem cell (hUCB-MSC) implantation for medial compartment (MC) osteoarthritis of the knee.

Materials and methods

Inclusion criteria were patients older than 60 years, with a kissing lesion of the MC, a full-thickness chondral defect ≥ 4 cm2 of the medial femoral condyle (MFC), and a varus deformity ≥ 3° on a long cassette scanogram. The mean age was 64.9 ± 4.4 years and the mean chondral defect of the MFC was 7.2 ± 1.9 cm2. A mixture of sodium hyaluronate and hUCB-MSC was implanted into the chondral defect and a high tibial osteotomy was performed in all patients. International Knee Documentation Committee (IKDC), visual analog scale (VAS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were evaluated preoperatively and 1 year and 2 years postoperatively. Cartilage regeneration was evaluated in 14 (56%) patients by second-look arthroscopy at 1 year postoperatively.

Results

Twenty-five patients underwent hUBC-MSC implantation. IKDC, VAS, and WOMAC scores at 1 year and 2 years improved significantly compared to preoperative scores. These scores at 1 year and 2 years were not significantly different between the body mass index (BMI) < 25 group and BMI ≥ 25 group. However, the < 65-year-old group showed superior IKDC scores at 1 year and 2 years and VAS score at 2 years than the ≥ 65-year-old group. Younger age and larger size of the chondral defect were associated with a significantly greater improvement in IKDC, VAS and WOMAC scores at 2 years. Second-look arthroscopy demonstrated International Cartilage Repair Society-Cartilage Repair Assessment grade I in six (42.9%) patients and grade II in eight (57.1%).

Conclusions

hUCB-MSC implantation regenerated cartilage satisfactorily and showed satisfactory clinical outcomes in patients older than 60 years who had MC osteoarthritis.

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References

  1. Singer SP, Dammerer D, Krismer M, Liebensteiner MC (2018) Maximum lifetime body mass index is the appropriate predictor of knee and hip osteoarthritis. Arch Orthop Trauma Surg 138:99–103

    Article  Google Scholar 

  2. Zhang Y, Jordan JM (2010) Epidemiology of osteoarthritis. Clin Geriatr Med 26:355–369

    Article  Google Scholar 

  3. Chatterji U, Ashworth MJ, Lewis PL, Dobson PJ (2015) Effect of total knee arthroplasty on recreational and sporting activity. ANZ J Surg 75:405–408

    Article  Google Scholar 

  4. Rosenberger RE, Gomoll AH, Bryant T, Minas T (2008) Repair of large chondral defects of the knee with autologous chondrocyte implantation in patients 45 years or older. Am J Sports Med 36:2336–2344

    Article  Google Scholar 

  5. Jiang YZ, Zhang SF, Qi YY et al (2011) Cell transplantation for articular cartilage defects: principles of past, present, and future practice. Cell Transplant 20:593–607

    Article  Google Scholar 

  6. Zhang W, Ouyang H, Dass CR, Xu J ((2015) ) Current research on pharmacologic and regenerative therapies for osteoarthritis. Bone Res 4:15040–59

    Article  CAS  Google Scholar 

  7. Knutsen G, Engebretsen L, Ludvigsen TC et al (2004) Autologous chondrocyte implantation compared with microfracture in the knee A randomized trial. J Bone Joint Surg Am 86-A:455–464

    Article  Google Scholar 

  8. Fong CY, Subramanian A, Gauthaman K et al (2018) Design and Processing Aspects of Polymer and Composite Materials. Stem Cell Rev 8:195–209

    Article  CAS  Google Scholar 

  9. Fong CY, Subramanian A, Biswas A et al (2010) Derivation efficiency, cell proliferation, frozen-thaw survival, ‘stemness’ properties, and differentiation of human Wharton’s jelly stem cells: their potential for concurrent banking with cord blood for regenerative medicine purposes. Reprod Biomed Online 21:391–401

    Article  Google Scholar 

  10. McIntyre JA, Jones IA, Danilkovich A, Vangsness CT Jr (2018) The placenta: applications in orthopaedic sports medicine. Am J Sports Med 46:234–247

    Article  Google Scholar 

  11. Park YB, Ha CW, Lee CH, Park YG (2017) Restoration of a large osteochondral defect of the knee using a composite of umbilical cord blood-derived mesenchymal stem cells and hyaluronic acid hydrogel: a case report with a 5-year follow-up. BMC Musculoskelet Disord 18:59

    Article  Google Scholar 

  12. Park YB, Ha CW, Lee CH, Yoon YC, Park YG (2017) Cartilage regeneration in osteoarthritic patients by a composite of allogeneic umbilical cord blood-derived mesenchymal stem cells and hyaluronate hydrogel: Results from a clinical trial for safety and proof-of-concept with 7 years of extended follow-up. Stem Cells Transl Med 6:613–621

    Article  CAS  Google Scholar 

  13. Miniaci A, Ballmer FT, Ballmer PM, Jakob RP (1989) Proximal tibial osteotomy. A new fixation device. Clin Orthop Relat Res 246:250–259

    Google Scholar 

  14. ICRS SCORE/GRADE. ICRS Clinical Cartilage Injury Evaluation System. https://cartilage.org/society/publications/icrs-score/. Accessed Feb 2017

  15. Gomoll AH, Filardo G, de Girolamo L et al (2012) Surgical treatment for early osteoarthritis. Part I: cartilage repair procedures. Knee Surg Sports Traumatol Arthrosc 20:450–466

    Article  CAS  Google Scholar 

  16. Marcacci M, Kon E, Grigolo B et al (2007) 8.3 The clinician view. Osteoarthr Cartilage 15:B11–B13

    Article  Google Scholar 

  17. Yubo M, Yanyan L, Li L, Tao S, Bo L, Lin C (2017) Clinical efficacy and safety of mesenchymal stem cell transplantation for osteoarthritis treatment: a meta-analysis. PLoS ONE 12:e0175449

    Article  Google Scholar 

  18. Koh YG, Kwon OR, Kim YS, Choi YJ (2014) Comparative outcomes of open-wedge high tibial osteotomy with platelet-rich plasma alone or in combination with mesenchymal stem cell treatment: a prospective study. Arthroscopy 30:1453–1460

    Article  Google Scholar 

  19. Vangsness CT Jr, Farr J 2nd, Boyd J, Dellaero DT, Mills CR, LeRoux-Williams M (2014) Adult human mesenchymal stem cells delivered via intra-articular injection to the knee following partial medial meniscectomy: a randomized, double-blind, controlled study. J Bone Joint Surg Am 96:90–98

    Article  Google Scholar 

  20. Vega A, Martin-Ferrero MA, Del Canto F et al (2015) Treatment of nee osteoarthritis with allogeneic bone marrow mesenchymal stem cells: a randomized controlled trial. Transplantation 99:1681–1690

    Article  CAS  Google Scholar 

  21. Kim SH, Ha CW, Park YB, Nam E, Lee JE, Lee HJ (2019) Intra-articular injection of mesenchymal stem cells for clinical outcomes and cartilage repair in osteoarthritis of the knee: a meta-analysis of randomized controlled trials. Arch Orthop Trauma Surg 139:971–980

    Article  Google Scholar 

  22. Stolzing A, Jones E, McGonagle D, Scutt A (2008) Age-related changes in human bone marrow-derived mesenchymal stem cells: consequences for cell therapies. Mec Ageing Dev 129:163–173

    Article  CAS  Google Scholar 

  23. Gobbi A, Whyte GP (2019) Long-term clinical outcomes of one-stage cartilage repair in the knee with hyaluronic acid-based scaffold embedded with mesenchymal stem cells sourced from bone marrow aspirate concentrate. Am J Sports Med 47:1621–1628

    Article  Google Scholar 

  24. Lamo-Espinosa JM, Mora G, Blanco JF et al (2016) Intra-articular injection of two different doses of autologous bone marrow mesenchymal stem cells versus hyaluronic acid in the treatment of knee osteoarthritis: multicenter randomized controlled clinical trial (phase I/II). J Transl Med 26 14(1):246

    Article  Google Scholar 

  25. Wong KL, Lee KB, Tai BC, Law P, Lee EH, Hui JH (2013) Injectable cultured bone marrow-derived mesenchymal stem cells in varus knees with cartilage defects undergoing high tibial osteotomy: a prospective, randomized controlled clinical trial with 2 years’ follow-up. Arthroscopy 29:2020–2028

    Article  Google Scholar 

  26. Ha CW, Park YB, Chung JY, Park YG (2015) Cartilage repair using composites of human umbilical cord blood-derived mesenchymal stem cells and hyaluronic acid hydrogel in a minipig model. Stem Cells Transl Med 4:1044–1051

    Article  CAS  Google Scholar 

  27. Jung WH, Takeuchi R, Chun CW et al (2014) Second-look arthroscopic assessment of cartilage regeneration after medial opening-wedge high tibial osteotomy. Arthroscopy 30:72–79

    Article  Google Scholar 

  28. Kim KI, Seo MC, Song SJ, Bae DK, Kim DH, Lee SH (2017) Change of chondral lesions and predictive factors after medial open-wedge high tibial osteotomy with a locked plate system. Am J Sports Med 45:1615–1621

    Article  Google Scholar 

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Acknowledgements

I would like to sincerely appreciate Ki-Taek Hong, MD for collection of PROs.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Seoul JS Hospital, Seoul, South Korea

    Jun-Seob Song, Ki-Taek Hong, Na-Min Kim & Han-Soo Park

  2. Department of Orthopaedic Surgery, Eulji Medical Center, Seoul, South Korea

    Nam-Hong Choi

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  1. Jun-Seob Song
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  2. Ki-Taek Hong
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  3. Na-Min Kim
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Correspondence to Nam-Hong Choi.

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All authors declare that they have no conflict of interest.

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This study was reviewed and approved by the institutional review board of the Korea Ministry of Health and Welfare.

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All patients signed an informed consent form.

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Song, JS., Hong, KT., Kim, NM. et al. Human umbilical cord blood-derived mesenchymal stem cell implantation for osteoarthritis of the knee. Arch Orthop Trauma Surg 140, 503–509 (2020). https://doi.org/10.1007/s00402-020-03349-y

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  • DOI: https://doi.org/10.1007/s00402-020-03349-y

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