Zampogna Biagio, Parisi Francesco Rosario, Ferrini Augusto, Zampoli Andrea, Papalia Giuseppe Francesco, Shanmugasundaram Saseendar, Papalia Rocco
Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Roma, Italy.
Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Roma, Italy.
J Clin Orthop Trauma. 2024 Nov 7;59:102804. doi: 10.1016/j.jcot.2024.102804. eCollection 2024 Dec.
Osteoarthritis (OA) is a progressive joint disease, and over 240 million people suffer from symptomatic OA, primarily in the knee, and mainly affects the elderly population over 65. A combination of different risk factors leads to biological changes in the microenvironments of the joints, causing cartilage overload and chondrocyte aging. Adipose-derived MSCs (ADSCs) are demonstrated to improve joint environments with an effective therapy for Knee OA. This review focused on patients over 65 years old to evaluate the effectiveness of ADSC therapies in treating KOA in elderly patients and demonstrate that complications are not higher in this cohort of patients.
We conducted a bibliography search through the PubMed, Scopus, and Cochrane databases for English-language and human clinical trials published until Feb 7, 2024. We extracted the following study characteristics: Authors, year of publication, type of study, number of patients, number of knees, sex, Kellgren-Lawrence classification, culture ADSC, Number of cells injected, mean follow-up, adverse events, significant complications, and clinical outcomes data were extracted recorded and analyzed.
According to inclusion criteria, seven clinical trials on autologous adipose-derived stem cells were considered. Four studies analyzed stem cells as a stromal vascular fraction (SVF), two as ADSC cultured, and 1 study investigated the MAT procedure. All studies reported improved clinical outcomes using autologous adipose-derived stem cells, on 339 knees. Post-treatment increased KOOS, WOMAC, IKS, VAS, and Lysholm knee scores were highlighted. All studies showed an improvement in all outcomes scores, and regarding complications, only 44 knees underwent adverse events, but no significant complications were found in all the studies reported.
The current systematic review demonstrated that using autologous adipose-derived stem cells improved clinical outcomes and is effective and safe in elderly patients. Additionally, this study will encourage orthopedic surgeons not to consider surgery as the only solution in elderly patients who are refractory to treatment and do not show end-stage knee osteoarthritis.
Level IV, systematic review of level IV studies
骨关节炎（OA）是一种进行性关节疾病，超过2.4亿人患有症状性OA，主要累及膝关节，且主要影响65岁以上的老年人群。多种不同风险因素共同作用导致关节微环境发生生物学变化，引起软骨负荷过重和软骨细胞衰老。脂肪来源的间充质干细胞（ADSCs）已被证明可通过有效治疗膝关节OA来改善关节环境。本综述聚焦于65岁以上患者，以评估ADSC疗法治疗老年患者膝关节OA的有效性，并证明该患者群体的并发症发生率并不更高。
我们通过PubMed、Scopus和Cochrane数据库进行文献检索，查找截至2024年2月7日发表的英文人类临床试验。我们提取了以下研究特征：作者、发表年份、研究类型、患者数量、膝关节数量、性别、凯尔格伦-劳伦斯分级、培养的ADSC、注射细胞数量、平均随访时间、不良事件、重大并发症，并提取记录和分析临床结局数据。
根据纳入标准，共纳入7项关于自体脂肪来源干细胞的临床试验。4项研究将干细胞分析为基质血管成分（SVF），2项研究分析培养的ADSC，1项研究调查了MAT程序。所有研究均报告使用自体脂肪来源干细胞改善了临床结局，涉及339个膝关节。治疗后KOOS、WOMAC、IKS、VAS和Lysholm膝关节评分均有所提高。所有研究均显示所有结局评分均有改善，关于并发症，仅44个膝关节出现不良事件，但所有报告的研究中均未发现重大并发症。
当前的系统评价表明，使用自体脂肪来源干细胞可改善临床结局，对老年患者有效且安全。此外，本研究将鼓励骨科医生不要将手术视为治疗难治且未表现出终末期膝关节骨关节炎的老年患者的唯一解决方案。
IV级，IV级研究的系统评价
