Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, 322 Seoyang-ro, Hwasun, Chonnam, 58128, Republic of Korea.
Knee Surg Sports Traumatol Arthrosc. 2022 Jan;30(1):208-218. doi: 10.1007/s00167-021-06450-w. Epub 2021 Jan 25.
The aim of this study was to compare clinical and second-look arthroscopic outcomes between bone marrow aspirate concentrate (BMAC) augmentation and human umbilical cord blood-derived mesenchymal stromal cell (hUCB-MSC) implantation in high tibial osteotomy (HTO) for medial compartmental knee osteoarthritis and identify the relationship between articular cartilage regeneration and HTO outcomes.
A total of 176 patients who underwent HTO combined with a BMAC or hUCB-MSC procedure for medial compartment osteoarthritis (Kellgren-Lawrence grade 3) between June 2014 and September 2018 with a minimum follow-up of 2 years were reviewed. After HTO, multiple holes were drilled at cartilage defect sites of the medial femoral condyle (MFC), and then prepared BMAC or hUCB-MSCs in combination with scaffolds were implanted in the MFC lesions. After propensity score matching based on sex, age, body mass index, and lesion size, 55 patients in each of the BMAC and hUCB-MSC groups were successfully matched. Second-look arthroscopic findings were assessed according to the International Cartilage Repair Society (ICRS) Cartilage Repair Assessment (CRA) grading system and Koshino staging system. Clinical outcomes were evaluated using the International Knee Documentation Committee (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS), Short-Form 36 (SF-36), and Tegner activity scores.
At a mean follow-up of 33 months, clinical outcomes including IKDC, KOOS, SF-36, and Tegner activity scores were significantly improved in both groups (p < 0.001); however, there were no differences between the two groups. Second-look arthroscopy showed better healing of regenerated cartilage in the hUCB-MSC group (Grade I [4 cases, 9.1%]; Grade II [30 cases, 68.2%]; Grade III [11 cases, 22.7%]) than in the BMAC group (Grade I [1 case, 2.7%]; Grade II [20 cases, 54.1%]; Grade III [11 cases, 29.7%]; Grade IV [5 cases, 13.5%]) according to the ICRS CRA grading system (p = 0.040). There was no significant intergroup difference in terms of defect coverage based on the Koshino staging system (p = 0.057). Moreover, ICRS CRA grades at second-look arthroscopy were significantly correlated with clinical outcomes (r = - 0.337; p = 0.002).
There were no significant differences in the clinical outcomes between the two groups. Both treatments provided similar, reliable outcomes in terms of pain relief, functional scores, and quality of life at a mean follow-up of 33 months. However, hUCB-MSC implantation was more effective than BMAC augmentation for articular cartilage regeneration.
本研究旨在比较骨髓抽吸浓缩物（BMAC）增强和人脐带血衍生间充质基质细胞（hUCB-MSC）植入在治疗内侧间室膝关节骨关节炎的高胫骨截骨术（HTO）中的临床和二次关节镜结果，并确定关节软骨再生与 HTO 结果之间的关系。
回顾 2014 年 6 月至 2018 年 9 月间因内侧间室骨关节炎（Kellgren-Lawrence 3 级）接受 HTO 联合 BMAC 或 hUCB-MSC 治疗的 176 例患者，随访时间至少 2 年。HTO 后，在股骨内侧髁（MFC）的软骨缺损部位进行多次钻孔，然后将制备的 BMAC 或 hUCB-MSCs 与支架一起植入 MFC 病变部位。基于性别、年龄、体重指数和病变大小进行倾向评分匹配后，BMAC 和 hUCB-MSC 组各成功匹配 55 例患者。根据国际软骨修复协会（ICRS）软骨修复评估（CRA）分级系统和 Koshino 分期系统评估二次关节镜检查结果。使用国际膝关节文献委员会（IKDC）、膝关节损伤和骨关节炎结果评分（KOOS）、简短形式 36（SF-36）和 Tegner 活动评分评估临床结果。
平均随访 33 个月时，两组的 IKDC、KOOS、SF-36 和 Tegner 活动评分均显著改善（p<0.001）；但两组之间无差异。二次关节镜检查显示 hUCB-MSC 组再生软骨的愈合情况更好（ICRS CRA 分级系统：I 级[4 例，9.1%]；II 级[30 例，68.2%]；III 级[11 例，22.7%]），而 BMAC 组较差（I 级[1 例，2.7%]；II 级[20 例，54.1%]；III 级[11 例，29.7%]；IV 级[5 例，13.5%]）（p=0.040）。根据 Koshino 分期系统，两组间缺损覆盖程度无显著差异（p=0.057）。此外，二次关节镜检查的 ICRS CRA 分级与临床结果显著相关（r=-0.337；p=0.002）。
两组间的临床结果无显著差异。在平均 33 个月的随访中，两种治疗方法在缓解疼痛、功能评分和生活质量方面均提供了相似的、可靠的结果。然而，与 BMAC 增强相比，hUCB-MSC 植入更有利于关节软骨再生。
