A non-scaffold method of mesenchymal stem cells autologous transplantation for deep knee cartilage lesions repair: 2 years results
Author(s):
Bukach D. (Belarus)
,
Bukach D. (Belarus)
Affiliations:
Eismont O.
Eismont O.
Affiliations:
ESSKA Academy. Bukach D. 05/09/18; 209318; P03-245 Topic: Arthroscopic Surgery
Dr. Dzmitry Bukach
Dr. Dzmitry Bukach
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Abstract
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Objectives: Mesenchymal stem cells (MSC) autologous transplantation seems to be a new effective method for local full thickness chondral and osteochondral lesions treatment. Good defect filling with hyaline like repair tissue and positive clinical outcome are expected. However, a few number of clinical trials is published. We developed a non-scaffold method of bone marrow (BM) MSC transplantation and earlier got a hyaline like tissue on canine model in experiment. The objective of this study was to examine the safety and the efficiency of developed MSC transplantation method in clinical trial.

Methods: 11 patients with local full thickness knee cartilage lesions caused by trauma or osteochondritis dissecans were treated by developed method. During the first stage surgery - arthroscopic knee evaluation, 56,4 ± 24,9 ml of bone marrow from pelvic crest was aspirated. During next 4 weeks in cell laboratory MSC from BM were separated, cultivated and differentiated with growth factors (TGF β and IGF) into chondral direction. The graft contained 26.8 ± 16.5 million MSC. Sodium hyaluronate was used as a graft matrix. For transplantation a non-scaffold local adherent technique from 3-4 cm mini access was used: the knee was positioned to let the refreshed cartilage defect locate horizontally, the MSC graft was dripped onto the cartilage defect with exposition for 10 minutes to let MSC adhere on defect surface. Full ROM with partial weight bearing was allowed for 6 weeks. We analyzed the dynamic of Visual Analogue Scale (VAS) and Lysholm Knee Scoring Scale before and during 2 years after surgery. The cartilage regenerate condition was examined by MRI at 6, 12 and 24 month and evaluated by MOCART scale. The MRI results of the investigated group were compared with control group results (17 patients) with full thickness cartilage defects, treated by bone marrow stimulation.

Results: No common and local complications were observed. VAS value reduced to an insignificant in most patients. Significant progressive improvement of Lysholm value was observed during 2 years after surgery (p<0.05). MRI shows repair tissue fills the defect sufficiently. Repair tissue improves its condition during the first two years after surgery. We found 2 cases of regenerate hypertrophy without clinical manifestations. Comparison of MSC group and BM stimulation group shows authentically better results of MOCART score in the first one group (p<0.05).

Conclusions: The results revealed the chondrogenic differentiated BM MSC graft due to local adhesion achieves regenerative recovery of cartilage injury. A significant improvement of clinical state is observed. MRI shows better quality of repair tissue after MSC transplantation than after BM stimulation. We conclude this method can be used for chondral and osteochondral repair.

Keywords:
Mesenchymal stem cells, Knee, Cartilage defect
Objectives: Mesenchymal stem cells (MSC) autologous transplantation seems to be a new effective method for local full thickness chondral and osteochondral lesions treatment. Good defect filling with hyaline like repair tissue and positive clinical outcome are expected. However, a few number of clinical trials is published. We developed a non-scaffold method of bone marrow (BM) MSC transplantation and earlier got a hyaline like tissue on canine model in experiment. The objective of this study was to examine the safety and the efficiency of developed MSC transplantation method in clinical trial.

Methods: 11 patients with local full thickness knee cartilage lesions caused by trauma or osteochondritis dissecans were treated by developed method. During the first stage surgery - arthroscopic knee evaluation, 56,4 ± 24,9 ml of bone marrow from pelvic crest was aspirated. During next 4 weeks in cell laboratory MSC from BM were separated, cultivated and differentiated with growth factors (TGF β and IGF) into chondral direction. The graft contained 26.8 ± 16.5 million MSC. Sodium hyaluronate was used as a graft matrix. For transplantation a non-scaffold local adherent technique from 3-4 cm mini access was used: the knee was positioned to let the refreshed cartilage defect locate horizontally, the MSC graft was dripped onto the cartilage defect with exposition for 10 minutes to let MSC adhere on defect surface. Full ROM with partial weight bearing was allowed for 6 weeks. We analyzed the dynamic of Visual Analogue Scale (VAS) and Lysholm Knee Scoring Scale before and during 2 years after surgery. The cartilage regenerate condition was examined by MRI at 6, 12 and 24 month and evaluated by MOCART scale. The MRI results of the investigated group were compared with control group results (17 patients) with full thickness cartilage defects, treated by bone marrow stimulation.

Results: No common and local complications were observed. VAS value reduced to an insignificant in most patients. Significant progressive improvement of Lysholm value was observed during 2 years after surgery (p<0.05). MRI shows repair tissue fills the defect sufficiently. Repair tissue improves its condition during the first two years after surgery. We found 2 cases of regenerate hypertrophy without clinical manifestations. Comparison of MSC group and BM stimulation group shows authentically better results of MOCART score in the first one group (p<0.05).

Conclusions: The results revealed the chondrogenic differentiated BM MSC graft due to local adhesion achieves regenerative recovery of cartilage injury. A significant improvement of clinical state is observed. MRI shows better quality of repair tissue after MSC transplantation than after BM stimulation. We conclude this method can be used for chondral and osteochondral repair.

Keywords:
Mesenchymal stem cells, Knee, Cartilage defect
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