Department of Orthopaedic Surgery and Traumatology, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium.
OrthoBiology Surgery Center, Tsimiski 43, 54623, Thessaloníki, Greece.
Knee Surg Sports Traumatol Arthrosc. 2020 Feb;28(2):502-508. doi: 10.1007/s00167-019-05688-9. Epub 2019 Sep 6.
The purpose of the present study was to investigate the mid-term outcomes of a single-stage cell-based procedure in patients with knee focal symptomatic cartilage defects using matrix-induced culture-expanded autologous AD-MSCs. It was hypothesised that the increased number of autologous AD-MSCs after culture expansion is a safe and efficient cartilage repair procedure, which improves overtime chondrogenesis in cartilage lesions METHODS: Twenty-five consecutive patients treated for a symptomatic cartilage defect were prospectively followed for 3 years. The median age of patients was 30.5 (range 16-43) with a median BMI of 23.6 kg/m (range 19-29) and an average size of the lesion of 3.5 cm (range 2-6). All patients underwent a single-stage procedure consisting in filling each defect with autologous culture-expanded mesenchymal stem cells embedded in a trimmed-to-fit commercially available biodegradable matrix. Pre-operative and post-operative evaluation included knee-related clinical and functional evaluation based on objective and subjective scores at 6, 12, 24 and 36 months and MRI evaluation of the repair tissue using the MOCART score at 12 and 24 months.
Clinical outcomes recorded significant improvements (p < 0.05) at the final follow-up compared with baseline as following: all subcategories of KOOS Score, the IKDC subjective from 40.9 (range 20.7-65.6) to 76.9 (range 42-90.3), Tegner Activity Score from 3 (range 2-4) to 4 (range 3-4), VAS for pain from 6 (range 4-8) to 1 (range 0-3). All patients improve significantly their IKDC objective scores. The MRI findings showed complete filling of the defect and integration to the border zone for 65% of the patients. Two patients underwent post-operative biopsies and the histological analysis demonstrated the presence of hyaline-like tissue.
Adipose-derived culture-expanded mesenchymal stem cells were shown to be an efficient and safe single-stage cell-based procedure for symptomatic, full-thickness knee chondral lesions. The findings of the present study demonstrate that all patients presented significant mid-term clinical, functional and radiological improvement.
IV.
本研究旨在探讨使用基质诱导培养扩增的自体脂肪源性间充质干细胞（AD-MSCs）对膝关节局灶性症状性软骨缺损进行单阶段细胞治疗的中期结果。我们假设培养扩增后的自体 AD-MSCs 数量增加是一种安全有效的软骨修复程序，可随着时间的推移改善软骨病变的软骨生成。
连续 25 例接受症状性软骨缺损治疗的患者前瞻性随访 3 年。患者的中位年龄为 30.5 岁（范围 16-43 岁），BMI 中位数为 23.6kg/m²（范围 19-29），病变平均大小为 3.5cm（范围 2-6）。所有患者均行单阶段手术，包括将自体培养扩增的间充质干细胞嵌入修剪至合适大小的商用可生物降解基质中，然后填充每个缺损。术前和术后评估包括基于客观和主观评分的膝关节相关临床和功能评估，在 6、12、24 和 36 个月时进行，并在 12 和 24 个月时使用 MOCART 评分进行修复组织的 MRI 评估。
临床结果记录显示，与基线相比，终末随访时均有显著改善（p < 0.05），如下：KOOS 评分的所有亚组、IKDC 主观评分从 40.9（范围 20.7-65.6）增加至 76.9（范围 42-90.3）、Tegner 活动评分从 3（范围 2-4）增加至 4（范围 3-4）、疼痛视觉模拟评分从 6（范围 4-8）降低至 1（范围 0-3）。所有患者的 IKDC 客观评分均显著提高。MRI 结果显示，65%的患者完全填充了缺损，并与边缘区整合。2 名患者接受了术后活检，组织学分析显示存在透明样组织。
脂肪源性培养扩增的间充质干细胞是一种有效且安全的单阶段细胞治疗方法，适用于膝关节局灶性、全层软骨缺损。本研究结果表明，所有患者均表现出明显的中期临床、功能和影像学改善。
IV。
