Orthopaedic Research Center, Colorado State University, Fort Collins, Colorado 80523, USA.
Arthroscopy. 2011 Nov;27(11):1552-61. doi: 10.1016/j.arthro.2011.06.002. Epub 2011 Aug 20.
This study evaluated intra-articular injection of bone marrow-derived mesenchymal stem cells (BMSCs) to augment healing with microfracture compared with microfracture alone.
Ten horses (aged 2.5 to 5 years) had 1-cm2 defects arthroscopically created on both medial femoral condyles of the stifle joint (analogous to the human knee). Defects were debrided to subchondral bone followed by microfracture. One month later, 1 randomly selected medial femorotibial joint in each horse received an intra-articular injection of either 20 × 10(6) BMSCs with 22 mg of hyaluronan or 22 mg of hyaluronan alone. Horses were confined for 4 months, with hand walking commencing at 2 weeks and then increasing in duration and intensity. At 4 months, horses were subjected to strenuous treadmill exercise simulating race training until completion of the study at 12 months. Horses underwent musculoskeletal and radiographic examinations bimonthly and second-look arthroscopy at 6 months. Horses were euthanized 12 months after the defects were made, and the affected joints underwent magnetic resonance imaging and gross, histologic, histomorphometric, immunohistochemical, and biochemical examinations.
Although there was no evidence of any clinically significant improvement in the joints injected with BMSCs, arthroscopic and gross evaluation confirmed a significant increase in repair tissue firmness and a trend for better overall repair tissue quality (cumulative score of all arthroscopic and gross grading criteria) in BMSC-treated joints. Immunohistochemical analysis showed significantly greater levels of aggrecan in repair tissue treated with BMSC injection. There were no other significant treatment effects.
Although there was no significant difference clinically or histologically in the 2 groups, this study confirms that intra-articular BMSCs enhance cartilage repair quality with increased aggrecan content and tissue firmness.
Clinical use of BMSCs in conjunction with microfracture of cartilage defects may be potentially beneficial.
本研究评估了与单纯微骨折相比，向关节内注射骨髓间充质干细胞（BMSCs）对微骨折愈合的增强作用。
10 匹马（2.5 至 5 岁）的膝关节（类似人膝关节）内侧股骨髁上各有 1 个 1cm2 的缺损。用微骨折法对缺损进行清创，直至软骨下骨。1 个月后，每匹马的随机选择的 1 个内侧股骨胫骨关节接受关节内注射 20×10（6）个 BMSCs 与 22mg 透明质酸或 22mg 透明质酸。马被限制 4 个月，2 周后开始手走，并逐渐增加时间和强度。4 个月时，马进行剧烈的跑步机运动，模拟比赛训练，直到 12 个月完成研究。马每 2 个月进行一次肌肉骨骼和放射学检查，6 个月时进行第二次关节镜检查。马在缺陷形成后 12 个月被安乐死，受影响的关节进行磁共振成像和大体、组织学、组织形态计量学、免疫组织化学和生物化学检查。
尽管关节内注射 BMSCs 没有任何临床显著改善的证据，但关节镜和大体评估证实，BMSC 治疗关节的修复组织硬度显著增加，整体修复组织质量有改善趋势（所有关节镜和大体分级标准的累积评分）。免疫组织化学分析显示，BMSC 注射治疗的修复组织中聚集蛋白聚糖水平显著升高。没有其他显著的治疗效果。
尽管两组在临床或组织学上没有显著差异，但本研究证实，关节内注射 BMSCs 可通过增加聚集蛋白聚糖含量和组织硬度来提高软骨修复质量。
BMSCs 与软骨缺陷的微骨折联合使用在临床上可能是有益的。
