Student research committee, faculty of medicine, Mashhad university of medical sciences, Mashhad, Iran; Department of medical biotechnology and nanotechnology, faculty of medicine, Mashhad university of medical sciences, Mashhad, Iran.
Student research committee, department of medical biotechnology, School of advanced technologies in medicine, Shahid Beheshti university of medical sciences, Tehran, Iran; Cellular and molecular biology research center, Shahid Beheshti university of medical sciences, Tehran, Iran.
Joint Bone Spine. 2021 Jan;88(1):105096. doi: 10.1016/j.jbspin.2020.105096. Epub 2020 Nov 3.
In recent years, studies have boosted our knowledge about the biology and disorders of articular cartilage. In this regard, the design of hydrogel-based scaffolds has advanced to improve cartilage repair. However, the efficacy of knee cartilage repair using hydrogels remains unclear. The aim of systematic review and meta-analysis was to scrutinize the efficiency of hydrogel-based therapy in correcting cartilage defects of knee (femoral condyle, patella, tibia plateau and trochlea).
The search was conducted in PubMed to gather articles published from 2004/1/1 to 2019/10/01, addressing the effects of implant of hydrogel on knee joint cartilage regeneration. The Cochrane Collaboration's tool for estimating the risk of bias was applied to check the quality of articles. The clinical data for meta-analysis was recorded using the visual analog scale (VAS), Lysholm score, WOMAC, and IKDC. The guidelines of Cochrane Handbook for Systematic Reviews of Interventions were utilized to conduct the review and meta-analysis in the RevMan 5.3 software.
The search resulted in 50 clinical trials that included 2846 patients, 986 of whom received cell-based hydrogel implants while 1860 patients used hydrogel without cell. There were significant differences comparing the pain scores based on the VAS (MD: -2.97; 95% CI: -3.15 to -2.79, P<0.00001) and WOMAC (MD: -25.22; 95% CI: -31.22 to -19.22, P<0.00001) between pre- and post-treatment with hydrogels. Furthermore, there were significant improvements in the functional scores based on the IKDC total score (MD: 30.67; P<0.00001) and the Lysholm knee scale (MD: 29.26; 95% CI: 26.74 to 31.78, P<0.00001). According to the Lysholm and IKDC score and after cumulative functional analysis, there was a significant improvement in this parameter (MD: 29.25; 95% CI: 27.26 to 31.25, P<0.00001).
This meta-analysis indicated clinically and statistically significant improvements in the pain score (VAS and WOMAC) and the functional score (IKDC and Lysholm) after the administration of hydrogel compared to pretreatment status. So, the current evidence shows the efficiency of hydrogel-based therapy in correcting and repairing knee cartilage defects.
近年来，研究增进了我们对关节软骨生物学和疾病的认识。在这方面，水凝胶基支架的设计已经得到了改进，以改善软骨修复。然而，水凝胶在膝关节软骨修复中的疗效仍不清楚。本系统评价和荟萃分析的目的是研究水凝胶治疗对膝关节（股骨髁、髌骨、胫骨平台和滑车）软骨缺损的疗效。
在 PubMed 上进行检索，收集 2004 年 1 月 1 日至 2019 年 10 月 1 日发表的关于水凝胶植入物对膝关节软骨再生影响的文章。应用 Cochrane 协作组评估偏倚风险的工具检查文章的质量。使用视觉模拟评分（VAS）、Lysholm 评分、WOMAC 和 IKDC 记录荟萃分析的临床数据。使用 Cochrane 干预系统评价手册中的指南在 RevMan 5.3 软件中进行综述和荟萃分析。
检索结果显示 50 项临床试验，共纳入 2846 例患者，其中 986 例接受细胞水凝胶植入物治疗，1860 例接受单纯水凝胶治疗。与治疗前相比，水凝胶治疗后的 VAS（MD：-2.97；95%CI：-3.15 至-2.79，P<0.00001）和 WOMAC（MD：-25.22；95%CI：-31.22 至-19.22，P<0.00001）评分均有显著差异。此外，IKDC 总评分（MD：30.67；P<0.00001）和 Lysholm 膝关节评分（MD：29.26；95%CI：26.74 至 31.78，P<0.00001）的功能评分也有显著改善。根据 Lysholm 和 IKDC 评分以及累积功能分析，该参数有显著改善（MD：29.25；95%CI：27.26 至 31.25，P<0.00001）。
本荟萃分析表明，与治疗前相比，水凝胶治疗后疼痛评分（VAS 和 WOMAC）和功能评分（IKDC 和 Lysholm）均有临床和统计学意义的改善。因此，目前的证据表明水凝胶治疗在纠正和修复膝关节软骨缺损方面是有效的。
