School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Department of Orthopedic Surgery, Wan Fang Hospital, Taipei Medical University, No. 111, Sec. 3, Xinglong Rd., Wenshan Dist., Taipei City 116, Taipei, Taiwan; Department of Orthopedic Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Orthop Traumatol Surg Res. 2020 Sep;106(5):977-983. doi: 10.1016/j.otsr.2020.04.008. Epub 2020 Jun 11.
Articular cartilage defect of the knee is a debilitating disease and marrow stimulation techniques (MST) is typically regarded as the first line of treatment for full thickness cartilage lesions. However, the ability of MST to induce the repair of cartilage defects with fibrocartilage is limited, raising concerns about the durability of the repaired tissue. Mesenchymal stem cells (MSCs) provide an alternative means of treating cartilage defects. Expanded MSCs transplantation following MST has achieved great success in animal studies, but relevant clinical results are still lacking.
Expanded MSCs transplantation could be an effective adjunctive therapy following MST for knee cartilage defects.
PubMed, EMBASE, and the Cochrane Library were systematically searched. This investigation considers articles that compare the effectiveness of expanded MSCs transplantation following MST (MSCs/MST) with that of MST alone for treating knee cartilage defects. Data on postoperative clinical outcomes were extracted. In an attempt to analyze trends over time in studies that report repeated measurements, an all time-points meta-analysis (ATM) was undertaken.
Five randomized controlled trials (RCTs) were included in this study. In a pooled analysis, the MSCs/MST group exhibited statistically significantly better postoperative international knee documentation committee subjective knee form (IKDC score) than the MST alone group during two years of follow-up (trend estimate through ATM, 0.27; 95% CI: 0.006 to 0.54). Lysholm scores were similarly favorable to MSCs/MST. The MSCs/MST group also yielded a statistically significantly higher magnetic resonance observation of cartilage repair tissue (MOCART) score at final follow-up (Mean Difference, 16.42; 95% CI: 4.44 to 28.40). No trial has identified serious adverse effects.
This meta-analysis demonstrate that expanded MSCs transplantation is a safe and effective adjunctive therapy. Further RCTs with long-term follow up and cost effectiveness analysis are needed.
I, Systematic review and meta-analysis.
膝关节软骨缺损是一种使人虚弱的疾病，骨髓刺激技术（MST）通常被视为全层软骨损伤的一线治疗方法。然而，MST 诱导纤维软骨修复软骨缺损的能力有限，这引发了对修复组织耐久性的担忧。间充质干细胞（MSCs）为治疗软骨缺损提供了另一种手段。在 MST 后进行扩增 MSC 移植已在动物研究中取得巨大成功，但相关的临床结果仍缺乏。
在 MST 后进行扩增 MSC 移植可能是治疗膝关节软骨缺损的一种有效辅助治疗方法。
系统检索了 PubMed、EMBASE 和 Cochrane 图书馆。本研究考虑了比较 MST 后进行扩增 MSC 移植（MSCs/MST）与单独 MST 治疗膝关节软骨缺损的有效性的文章。提取术后临床结果数据。为了分析报告重复测量的研究中随时间的趋势，进行了全时间点荟萃分析（ATM）。
本研究纳入了 5 项随机对照试验（RCT）。在汇总分析中，MSCs/MST 组在两年的随访中，术后国际膝关节文献委员会主观膝关节评分（IKDC 评分）明显优于单独 MST 组（ATM 趋势估计，0.27；95%CI：0.006 至 0.54）。Lysholm 评分也对 MSCs/MST 有利。MSCs/MST 组在最终随访时的磁共振观察软骨修复组织（MOCART）评分也明显更高（平均差值，16.42；95%CI：4.44 至 28.40）。没有试验发现严重不良事件。
本荟萃分析表明，扩增 MSCs 移植是一种安全有效的辅助治疗方法。需要进一步进行长期随访和成本效益分析的 RCT。
I，系统评价和荟萃分析。
