Cell-based tissue engineering approaches that use mesenchymal stem cells (MSCs) have addressed the issue of articular cartilage repair in knee osteoarthritis (OA). However, the most effective method of cartilage repair procedures has not been established. This study aimed to compare the clinical, radiological, and second-look arthroscopic outcomes related to two different cartilage repair procedures (implantation of MSCs or MSCs with allogenic cartilage) with concomitant high tibial osteotomy (HTO).
: Seventy patients treated with cartilage repair procedures and concomitant HTO were prospectively randomized into 2 groups: MSC implantation (MSC group), and implantation of MSCs with allogenic cartilage (MSC-AC group). Clinical outcomes were evaluated using the Lysholm Score and the Knee Injury and Osteoarthritis Outcome Score. Radiological outcomes were evaluated by measuring the femorotibial angle and posterior tibial slope. During second-look arthroscopy, cartilage regeneration was evaluated according to the Kanamiya grade.
Clinical outcomes at the second-look arthroscopy improved significantly in both groups (P < 0.001 for all). Further improvement of clinical outcomes from the second-look arthroplasty to the final follow-up was observed only in the MSC-AC group (P < 0.05 for all). Overall, the Kanamiya grades, which were significantly correlated with clinical outcomes, were significantly higher in the MSC-AC group than in the MSC group. Radiological outcomes at final follow-up revealed improved knee joint alignments relative to preoperative conditions, but there was no significant correlation between clinical outcomes and Kanamiya grade in either group (P > 0.05 for all).
Implantation of MSCs with allogenic cartilage is superior to implantation of MSCs alone in cartilage regeneration accompanied with better clinical outcomes.