Venosa Michele, Calafiore Francesco, Mazzoleni Manuel, Romanini Emilio, Cerciello Simone, Calvisi Vittorio
Department of Life, Health and Environmental Sciences, University of L'Aquila, Via Vetoio Coppito 2, 67100 - L'Aquila, Italy.
RomaPro Center for Hip and Knee Arthroplasty - Polo Sanitario San Feliciano, Via Mattia Battistini, 44, 00167 - Rome, Italy.
Adv Orthop. 2022 Apr 28;2022:6048477. doi: 10.1155/2022/6048477. eCollection 2022.
This study aims to compare the effects of platelet-rich plasma (PRP) alone or in combination with adipose-derived mesenchymal stem cells (AD-MSCs) in patients affected by cartilage defects, undergoing knee arthroscopic microfracture.
Thirty-eight patients diagnosed with a knee monocompartmental cartilage defect (Outerbridge grade IV) on the MRI, underwent an arthroscopic procedure. After the confirmation of the lesion, they all received the same bone marrow stimulation technique (microfracture) and were randomized into two groups: the first one had additional PRP injection (group A), while the second received PRP and AD-MSC injection (group B). Knee assessment and pain score were documented with Knee Injury Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) score, Short-Form (SF) 12, and Visual Analogue Scale (VAS) before the treatment and at 1, 3, 6, and 12 months of follow-up postoperatively. An additional arthroscopic procedure, performed in four patients for a subsequent meniscal lesion, let us evaluate cartilage evolution by performing a macro/microscopical assessment on cartilage biopsy specimens.
At the 12-month follow-up, both groups showed a comparable functional improvement. The scores on the IKDC form, KOOS, pain VAS, and SF-12 significantly improved from baseline ( < 0.05) to 12 months postoperatively in both treatment groups. The four second-look arthroscopies showed a complete repair of the articular defects by smooth solid cartilage layer, with a good chondrocytic population, in both groups. A thick smooth hyaline-like cartilage with a predominantly viable cell population and normal mineralization (a form closely resembling native tissue) was observed in group B.
Modern regenerative medicine techniques, such as PRP and AD-MSC, associated with traditional arthroscopic bone marrow stimulating techniques, seem to enhance cartilage restoration ability. The preliminary results of this pilot study encourage the synergic use of these regenerative modulating systems to improve the quality of the regenerated cartilage.
本研究旨在比较富血小板血浆（PRP）单独使用或与脂肪来源间充质干细胞（AD-MSCs）联合使用对接受膝关节镜下微骨折治疗的软骨缺损患者的影响。
38例经磁共振成像（MRI）诊断为膝关节单髁软骨缺损（Outerbridge Ⅳ级）的患者接受了关节镜手术。在确认病变后，他们均接受相同的骨髓刺激技术（微骨折），并随机分为两组：第一组额外注射PRP（A组），第二组接受PRP和AD-MSCs注射（B组）。在治疗前以及术后1、3、6和12个月的随访中，使用膝关节损伤骨关节炎结局评分（KOOS）、国际膝关节文献委员会（IKDC）评分、简短健康调查（SF）-12和视觉模拟量表（VAS）记录膝关节评估和疼痛评分。4例患者因随后的半月板损伤接受了额外的关节镜手术，通过对软骨活检标本进行宏观/微观评估，我们得以评估软骨的演变情况。
在12个月的随访中，两组均显示出相当的功能改善。在两个治疗组中，IKDC表格评分、KOOS评分、疼痛VAS评分和SF-12评分从基线到术后12个月均有显著改善（<0.05）。4例二次关节镜检查显示，两组的关节缺损均通过光滑的坚实软骨层完全修复，软骨细胞数量良好。在B组中观察到一层厚的光滑透明样软骨，主要为存活细胞群且矿化正常（一种与天然组织非常相似的形式）。
现代再生医学技术，如PRP和AD-MSCs，与传统的关节镜下骨髓刺激技术相结合，似乎能增强软骨修复能力。这项初步研究的结果鼓励协同使用这些再生调节系统，以提高再生软骨的质量。
