Center for Stem Cell & Arthritis Research, Department of Orthopedic Surgery, Yonsei Sarang Hospital, Seoul, South Korea.
Arthroscopy. 2013 Apr;29(4):748-55. doi: 10.1016/j.arthro.2012.11.017. Epub 2013 Jan 29.
The purpose of this study was to evaluate the clinical and imaging results of patients who received intra-articular injections of autologous mesenchymal stem cells for the treatment of knee osteoarthritis.
The study group comprised 18 patients (6 men and 12 women), among whom the mean age was 54.6 years (range, 41 to 69 years). In each patient the adipose synovium was harvested from the inner side of the infrapatellar fat pad by skin incision extension at the arthroscopic lateral portal site after the patient underwent arthroscopic debridement. After stem cells were isolated, a mean of 1.18 × 10(6) stem cells (range, 0.3 × 10(6) to 2.7 × 10(6) stem cells) were prepared with approximately 3.0 mL of platelet-rich plasma (with a mean of 1.28 × 10(6) platelets per microliter) and injected into the selected knees of patients. Clinical outcome was evaluated with the Western Ontario and McMaster Universities Osteoarthritis Index, the Lysholm score, and the visual analog scale (VAS) for grading knee pain. We also compared magnetic resonance imaging (MRI) data collected both preoperatively and at the final follow-up.
Western Ontario and McMaster Universities Osteoarthritis Index scores decreased significantly (P < .001) from 49.9 points preoperatively to 30.3 points at the final follow-up (mean follow-up, 24.3 months; range, 24 to 26 months). Lysholm scores also improved significantly (P < .001) by the last follow-up visit, increasing from a mean preoperative value of 40.1 points to 73.4 points by the end of the study. Likewise, changes in VAS scores throughout the follow-up period were also significant (P = .005); the mean VAS score decreased from 4.8 preoperatively to 2.0 at the last follow-up visit. Radiography showed that, at the final follow-up point, the whole-organ MRI score had significantly improved from 60.0 points to 48.3 points (P < .001). Particularly notable was the change in cartilage whole-organ MRI score, which improved from 28.3 points to 21.7 points (P < .001). Further analysis showed that improvements in clinical and MRI results were positively related to the number of stem cells injected.
The results of our study are encouraging and show that intra-articular injection of infrapatellar fat pad-derived mesenchymal stem cells is effective for reducing pain and improving knee function in patients being treated for knee osteoarthritis.
Level IV, therapeutic case series.
本研究旨在评估接受关节内注射自体间充质干细胞治疗膝骨关节炎患者的临床和影像学结果。
研究组包括 18 名患者（6 名男性和 12 名女性），平均年龄为 54.6 岁（范围，41 岁至 69 岁）。在每位患者的关节镜外侧入路处，通过皮肤切口延长，从髌下脂肪垫内侧采集脂肪滑膜。在分离干细胞后，用大约 3.0 毫升富含血小板的血浆（平均每微升含有 1.28×106 个血小板）制备平均 1.18×106 个干细胞（范围，0.3×106 至 2.7×106 个干细胞），并将其注入患者选定的膝关节中。临床结果通过 Western Ontario 和 McMaster 大学骨关节炎指数、Lysholm 评分和视觉模拟评分（VAS）进行评估，用于分级膝关节疼痛。我们还比较了术前和最终随访时收集的磁共振成像（MRI）数据。
Western Ontario 和 McMaster 大学骨关节炎指数评分从术前的 49.9 分显著降低（P<0.001）至最终随访时的 30.3 分（平均随访时间，24.3 个月；范围，24 至 26 个月）。Lysholm 评分也在最后一次随访时显著提高（P<0.001），从术前的平均 40.1 分增加到研究结束时的 73.4 分。同样，整个随访期间 VAS 评分的变化也具有统计学意义（P=0.005）；VAS 评分从术前的 4.8 分降至最后一次随访时的 2.0 分。放射摄影显示，在最终随访点，整个关节 MRI 评分从 60.0 分显著改善至 48.3 分（P<0.001）。特别值得注意的是软骨整个器官 MRI 评分的变化，从 28.3 分改善至 21.7 分（P<0.001）。进一步分析表明，临床和 MRI 结果的改善与注射的干细胞数量呈正相关。
我们的研究结果令人鼓舞，表明髌下脂肪垫来源的间充质干细胞关节内注射可有效减轻膝骨关节炎患者的疼痛并改善膝关节功能。
IV 级，治疗性病例系列。
