Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul 06973, Republic of Korea.
Arthroscopy. 2019 Jan;35(1):277-288.e2. doi: 10.1016/j.arthro.2018.07.028. Epub 2018 Nov 16.
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.
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.
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).
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 III; systematic review of level I, II, and III studies.
系统综述关于间充质干细胞（MSCs）在治疗膝骨关节炎患者的临床疗效（包括疼痛和功能）和软骨修复的临床文献。
我们通过 MEDLINE、EMBASE、Cochrane 图书馆、CINAHL、Web of Science 和 Scopus 系统地检索了所有关于细胞群体中包含 MSCs 的临床应用在膝骨关节炎患者中临床疗效和软骨修复的研究。研究遵循系统评价和荟萃分析的 Preferred Reporting Items 指南。排除证据水平为 IV 或 V 的研究。使用改良 Coleman 方法学评分评估方法学质量。使用临床评分评估临床结果，使用磁共振成像和二次关节镜检查结果评估软骨修复。
共有 50 篇全文研究中符合标准的 17 项研究纳入本综述，其中 6 项为随机对照试验，8 项为前瞻性观察研究，3 项为回顾性病例对照研究。在 17 项研究中，8 项使用骨髓来源的 MSCs，6 项使用脂肪组织来源的基质血管成分，2 项使用脂肪组织来源的 MSCs，1 项使用脐带血来源的 MSCs。除 2 项研究外，其余所有研究均报告 MSC 组的临床结果明显更好，或在最终随访时临床结果改善。在软骨修复方面，11 项研究中有 9 项报告磁共振成像上软骨状态改善，7 项研究中有 6 项报告二次关节镜检查中有修复组织。改良 Coleman 方法学评分平均为 55.5±15.5（范围，28-74）。
在许多情况下，关节内注射 MSCs 可在短期（<28 个月）随访时改善膝骨关节炎的疼痛和功能。MSCs 对骨关节炎软骨修复有一定疗效；然而，关节内注射 MSCs 对临床疗效和软骨修复的疗效证据仍然有限。
三级；对 I、II、III 级研究的系统评价。
