Bae Bo Seung, Jung Jae Woong, Jo Gyeong Ok, Kim Seon Ae, Go Eun Jeong, Cho Mi-La, Shetty Asode Ananthram, Kim Seok Jung
Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
The Rheumatism Research Center, Catholic Research Institute of Medical Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Stem Cell Res Ther. 2025 Apr 28;16(1):211. doi: 10.1186/s13287-025-04356-9.
Delaying total knee arthroplasty is crucial for middle-aged patients with severe osteoarthritis. The long-term outcomes of high tibial osteotomy (HTO) remain uncertain. Recently, mesenchymal stem cells (MSCs) have shown promising potential in enhancing cartilage regeneration. Therefore, this study aimed to assess cartilage regeneration following the implantation of allogeneic human umbilical cord blood-derived mesenchymal stem cells (hUCB-MSCs) with HTO.
In this case series, ten patients underwent hUCB-MSC implantation with HTO. The median age was 58.50 (range: 57.00-60.00) years, and the mean body mass index was 27.81 (range: 24.42-32.24) kg/m. Clinical outcomes, including the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analog scale (VAS), Physical Component Score (PCS) and Mental Component Score (MCS) from the 36-Item Short-Form Health Survey (SF-36), were evaluated 6 months, 1 year, and 2 years postoperatively. Cartilage status of the medial femoral condyle (MFC) was assessed during hardware removal surgery, at least 2 years after the initial procedure, and compared with preoperative MFC cartilage status regarding lesion size and International Cartilage Repair Society (ICRS) grade. Radiological assessments included the Kellgren-Lawrence (KL) grading system for medial compartment osteoarthritis and hip-knee-ankle (HKA) angle.
Significant improvements were observed in WOMAC scores (preoperative: 57.00 (range: 44.75-63.00), postoperative: 27.50 (range: 22.25-28.75)), VAS scores (preoperative: 66.25 (range: 48.00-74.25), postoperative: 26.25 (range: 14.50-31.13)), SF-36 PCS (preoperative: 27.97 (range: 26.64-31.25), postoperative: 55.31 (range: 51.64-62.50)), and SF-36 MCS (preoperative: 41.04 (range: 29.95-50.96), postoperative: 63.18 (range: 53.83-65.16)) 2 years postoperatively (p = 0.002, 0.002, 0.002, and 0.020, respectively). The MFC chondral lesion demonstrated significant improvement in both lesion size (preoperative: 7.00 cm² (range: 4.38-10.50 cm²), postoperative: 0.16 cm² (range: 0.00-1.75 cm²), p = 0.002) and ICRS grade (preoperative: 4 (range: 4-4), postoperative: 1 (range: 1-2.25), p = 0.002). Additionally, the KL grade significantly decreased from 3 (range: 3-3) preoperatively to 2 (range: 2-2) postoperatively, while the HKA angle was corrected from 7.50° (range: 7.00-10.25°) preoperatively to -1.00° (range: -3.5-0.00°) postoperatively.
hUCB-MSC implantation with HTO is an effective treatment for medial compartment osteoarthritis and varus deformities, resulting in significant improvements in cartilage regeneration and overall clinical outcomes.
NCT04234412.
对于患有严重骨关节炎的中年患者而言，延迟全膝关节置换术至关重要。高位胫骨截骨术（HTO）的长期疗效仍不确定。近来，间充质干细胞（MSCs）在促进软骨再生方面显示出了有前景的潜力。因此，本研究旨在评估异体人脐带血源性间充质干细胞（hUCB - MSCs）与HTO联合植入后的软骨再生情况。
在本病例系列研究中，10例患者接受了hUCB - MSCs与HTO联合治疗。中位年龄为58.50（范围：57.00 - 60.00）岁，平均体重指数为27.81（范围：24.42 - 32.24）kg/m²。在术后6个月、1年和2年评估临床结局，包括西安大略和麦克马斯特大学骨关节炎指数（WOMAC）、视觉模拟评分（VAS）、来自36项简短健康调查问卷（SF - 36）的生理健康评分（PCS）和心理健康评分（MCS）。在初次手术后至少2年的取出内固定手术时评估股骨内侧髁（MFC）的软骨状态，并将其与术前MFC软骨状态在病变大小和国际软骨修复协会（ICRS）分级方面进行比较。放射学评估包括用于内侧间室骨关节炎的Kellgren - Lawrence（KL）分级系统和髋 - 膝 - 踝（HKA）角。
术后2年时，WOMAC评分（术前：57.00（范围：44.75 - 63.00），术后：27.50（范围：22.25 - 28.75））、VAS评分（术前：66.25（范围：48.00 - 74.25），术后：26.25（范围：14.50 - 31.13））、SF - 36 PCS（术前：27.97（范围：26.64 - 31.25），术后：55.31（范围：51.64 - 62.50））和SF - 36 MCS（术前：41.04（范围：29.95 - 50.96），术后：63.18（范围：53.83 - 65.16））均有显著改善（p分别为0.002、0.002、0.002和0.020）。MFC软骨损伤在病变大小（术前：7.00 cm²（范围：4.38 - 10.50 cm²），术后：0.16 cm²（范围：0.00 - 1.75 cm²），p = 0.002）和ICRS分级（术前：4（范围：4 - 4），术后：1（范围：1 - 2.25），p = 0.002）方面均有显著改善。此外，KL分级从术前的3（范围：3 - 3）显著降至术后的2（范围：2 - 2），而HKA角从术前的7.50°（范围：7.00 - 10.25°）矫正至术后的 - 1.00°（范围： - 3.5 - 0.00°）。
hUCB - MSCs与HTO联合植入是治疗内侧间室骨关节炎和内翻畸形的有效方法，可显著改善软骨再生和整体临床结局。
NCT04234412。
