Fares Mohamad Y, Daher Mohammad, Boufadel Peter, Haikal Emil, Haj Shehade Tarek, Koa Jonathan, Khan Adam Z, Abboud Joseph A
Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA.
Southern California Permanente Medical Group, Panorama City, CA, USA.
Cell Tissue Bank. 2024 Dec 27;26(1):5. doi: 10.1007/s10561-024-10154-z.
Tissue engineering and cartilage transplantation constitute an evolving field in the treatment of osteoarthritis, with therapeutic and clinical promise shown in autologous chondrocyte implantation. The aim of this systematic review is to explore current clinical trials that utilized autologous chondrocyte transplantation (ACT) and assess its efficacy in the treatment of osteoarthritis. PubMed, Ovid MEDLINE, and Google-Scholar (pages 1-20) were searched up until February 2023. Inclusion criteria consisted of clinical trials that involve autologous cartilage transplantation for the treatment of osteoarthritis. Clinical, imaging, arthroscopic, and histologic outcomes were assessed. A total of 15 clinical trials, involving 851 participants, were included in the study. All trials utilized ACT in the treatment of knee osteoarthritis through varying scaffolds: collagen-based (10 trials), polymer-based (2 trials), hyaluronic-acid based (2 trials), and spheroid technology (1 trial). Clinical improvement of patients undergoing ACT was noted in 14 trials; five showed superior clinical outcomes compared to the control group, while one showed inferiority compared to mesenchymal stem cells. Postoperative imaging was utilized to assess the degree of cartilage regeneration in 11 trials. Ten trials showed signs of cartilage recovery with ACT, four trials showed no difference, and two showed worse outcomes when compared to controls. Second-look-arthroscopy was performed in three trials, which reported varying degrees of improvement in cartilage regeneration. Histologic analysis was performed in four trials and generally showed promising results. While improved clinical outcomes were demonstrated, conflicting findings in postoperative outcome analysis raise questions about the unequivocal utility of ACT. Additional research with control groups, randomization, and appropriate blinding is required.
组织工程和软骨移植是骨关节炎治疗领域中一个不断发展的方向，自体软骨细胞植入已展现出治疗和临床应用前景。本系统评价的目的是探索目前使用自体软骨细胞移植（ACT）的临床试验，并评估其治疗骨关节炎的疗效。检索了截至2023年2月的PubMed、Ovid MEDLINE和谷歌学术（第1 - 20页）。纳入标准包括涉及自体软骨移植治疗骨关节炎的临床试验。对临床、影像学、关节镜和组织学结果进行了评估。该研究共纳入15项临床试验，涉及851名参与者。所有试验均通过不同支架使用ACT治疗膝关节骨关节炎：基于胶原蛋白的（10项试验）、基于聚合物的（2项试验）、基于透明质酸的（2项试验）和球体技术（1项试验）。14项试验记录了接受ACT治疗患者的临床改善情况；5项试验显示与对照组相比临床结果更优，而1项试验显示与间充质干细胞相比结果较差。11项试验利用术后影像学评估软骨再生程度。10项试验显示ACT有软骨恢复迹象，4项试验显示无差异，2项试验显示与对照组相比结果更差。3项试验进行了二次关节镜检查，报告软骨再生有不同程度改善。4项试验进行了组织学分析，总体显示出有前景的结果。虽然临床结果有所改善，但术后结果分析中的矛盾发现引发了对ACT明确效用的质疑。需要进行有对照组、随机化和适当盲法的进一步研究。
