Department of Orthopaedic and Trauma Surgery, Perugia Hospital, Perugia, Italy.
Eur Rev Med Pharmacol Sci. 2021 Dec;25(24):7754-7764. doi: 10.26355/eurrev_202112_27622.
Conservative and surgical treatments for meniscal lesions are various and this field of orthopedic surgery is in continuous development. Stem cells represent one of the current options to stimulate meniscal healing. The present systematic review aimed at summarizing the state of art in the application of stem cells for the treatment of meniscal damage both at pre-clinical and clinical level.
The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to perform this systematic review. A systematic search was performed using the PubMed (MEDLINE), EMBASE and Cochrane Library databases. All the studies dealing with the application of stem cells as a treatment for meniscal tears were pooled, data were extracted and analyzed. The studies were divided into two groups (pre-clinical and clinical), and then, discussed independently.
A total of 18 studies were included. Thirteen were classified as "pre-clinical" and five as "clinical". The most commonly used cells were mesenchymal stem cells (MSC), derived from bone marrow (BMMSC), synovial tissue (SMSC), or adipose tissue (ADSC). Follow-ups ranged from 2 to 16 weeks for the pre-clinical studies and from 3 to 24 months for the clinical studies. All studies documented good results in terms of laboratory markers/scores, clinical and radiologic evaluation.
Based on the currently available data, it is not possible to establish the best cell source or delivery method for the treatment of meniscal injuries. Bone Marrow derived stem cells delivered through injection represent the most studied approach, with the most promising results. However, the full impact of these therapies through their different sub-type of stem cells and implantation techniques still needs to be critically analyzed through larger randomized controlled trials with longer follow-up.
半月板病变的保守和手术治疗方法多种多样，骨科领域也在不断发展。干细胞是刺激半月板愈合的当前选择之一。本系统评价旨在总结干细胞治疗半月板损伤的临床前和临床应用的最新进展。
遵循 PRISMA（系统评价和荟萃分析的首选报告项目）指南进行本系统评价。使用 PubMed（医学文献在线数据库）、EMBASE 和 Cochrane 图书馆数据库进行系统搜索。汇总了所有涉及干细胞作为半月板撕裂治疗应用的研究，提取并分析数据。将研究分为两组（临床前和临床），然后分别讨论。
共纳入 18 项研究。其中 13 项被归类为“临床前”，5 项为“临床”。最常用的细胞是间充质干细胞（MSC），来源于骨髓（BMMSC）、滑膜组织（SMSC）或脂肪组织（ADSC）。临床前研究的随访时间为 2 至 16 周，临床研究的随访时间为 3 至 24 个月。所有研究均记录了实验室标志物/评分、临床和影像学评估方面的良好结果。
根据目前可用的数据，尚无法确定治疗半月板损伤的最佳细胞来源或输送方法。通过注射给药的骨髓来源干细胞是研究最多的方法，结果最有前景。然而，这些治疗方法通过不同的干细胞亚型和植入技术的全部影响仍需要通过更长时间的随访、更大规模的随机对照试验进行批判性分析。
