Allogenic umbilical cord blood-derived mesenchymal stromal cell implantation was superior to bone marrow aspirate concentrate augmentation for cartilage regeneration despite similar clinical outcomes

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Vol. 30; no. 1; pp. 208 - 218
• Main Authors: Yang, Hong-Yeol, Song, Eun-Kyoo, Kang, Sung-Ju, Kwak, Woo-Kyoung, Kang, Joon-Kyoo, Seon, Jong-Keun
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 2022; Springer Nature B.V
• Subjects: Arthritis; Arthroscopy; Augmentation; Biomedical materials; Blood; Body mass; Body mass index; Body size; Bone Marrow; Cartilage; Cartilage (articular); Cartilage diseases; Cartilage, Articular - surgery; Clinical outcomes; Cord blood; Fetal Blood; Humans; Implantation; Knee; Knee Joint; Lesions; Medicine; Medicine & Public Health; Mesenchymal Stem Cells; Mesenchyme; Orthopedics; Osteoarthritis; Osteoarthritis, Knee; Osteotomy; Pain; Patients; Quality of Life; Regeneration; Repair; Second-Look Surgery; Sports Medicine; Treatment Outcome; Umbilical cord; Cartilage regeneration; BMAC; Second-look arthroscopy; hUCB-MSC; High tibial osteotomy; Clinical outcomes
• DOI: 10.1007/s00167-021-06450-w
• ISSN: 0942-2056

Purpose The aim of this study was to compare clinical and second-look arthroscopic outcomes between bone marrow aspirate concentrate (BMAC) augmentation and human umbilical cord blood-derived mesenchymal stromal cell (hUCB-MSC) implantation in high tibial osteotomy (HTO) for medial compartmental knee osteoarthritis and identify the relationship between articular cartilage regeneration and HTO outcomes. Methods A total of 176 patients who underwent HTO combined with a BMAC or hUCB-MSC procedure for medial compartment osteoarthritis (Kellgren–Lawrence grade 3) between June 2014 and September 2018 with a minimum follow-up of 2 years were reviewed. After HTO, multiple holes were drilled at cartilage defect sites of the medial femoral condyle (MFC), and then prepared BMAC or hUCB-MSCs in combination with scaffolds were implanted in the MFC lesions. After propensity score matching based on sex, age, body mass index, and lesion size, 55 patients in each of the BMAC and hUCB-MSC groups were successfully matched. Second-look arthroscopic findings were assessed according to the International Cartilage Repair Society (ICRS) Cartilage Repair Assessment (CRA) grading system and Koshino staging system. Clinical outcomes were evaluated using the International Knee Documentation Committee (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS), Short-Form 36 (SF-36), and Tegner activity scores. Results At a mean follow-up of 33 months, clinical outcomes including IKDC, KOOS, SF-36, and Tegner activity scores were significantly improved in both groups ( p  < 0.001); however, there were no differences between the two groups. Second-look arthroscopy showed better healing of regenerated cartilage in the hUCB-MSC group (Grade I [4 cases, 9.1%]; Grade II [30 cases, 68.2%]; Grade III [11 cases, 22.7%]) than in the BMAC group (Grade I [1 case, 2.7%]; Grade II [20 cases, 54.1%]; Grade III [11 cases, 29.7%]; Grade IV [5 cases, 13.5%]) according to the ICRS CRA grading system ( p  = 0.040). There was no significant intergroup difference in terms of defect coverage based on the Koshino staging system ( p  = 0.057). Moreover, ICRS CRA grades at second-look arthroscopy were significantly correlated with clinical outcomes ( r  = − 0.337; p  = 0.002). Conclusion There were no significant differences in the clinical outcomes between the two groups. Both treatments provided similar, reliable outcomes in terms of pain relief, functional scores, and quality of life at a mean follow-up of 33 months. However, hUCB-MSC implantation was more effective than BMAC augmentation for articular cartilage regeneration.