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. 2019 Jun 28:11:106-113.
doi: 10.1016/j.reth.2019.06.002. eCollection 2019 Dec.

Transplantation of autologous bone marrow-derived mesenchymal stem cells under arthroscopic surgery with microfracture versus microfracture alone for articular cartilage lesions in the knee: A multicenter prospective randomized control clinical trial

Yusuke Hashimoto  1 , Yohei Nishida  1 , Shinji Takahashi  1 , Hiroaki Nakamura  1 , Hisashi Mera  2 , Kaori Kashiwa  3 , Shinichi Yoshiya  3 , Yusuke Inagaki  4 , Kota Uematsu  4 , Yasuhito Tanaka  4 , Shigeki Asada  5 , Masao Akagi  5 , Kanji Fukuda  6 , Yoshiya Hosokawa  7 , Akira Myoui  7 , Naosuke Kamei  8 , Masakazu Ishikawa  8 , Nobuo Adachi  8 , Mitsuo Ochi  8 , Shigeyuki Wakitani  9
Affiliations

Transplantation of autologous bone marrow-derived mesenchymal stem cells under arthroscopic surgery with microfracture versus microfracture alone for articular cartilage lesions in the knee: A multicenter prospective randomized control clinical trial

Yusuke Hashimoto et al. Regen Ther. .

Abstract

Introduction: To investigate the efficacy of the transplantation of autologous bone marrow-derived mesenchymal stem cells (BMSCs) under arthroscopy with microfracture (MFX) compared with microfracture alone.

Methods: Eleven patients with a symptomatic articular cartilage defect of the knee were included in the study. They were randomized to receive BMSCs with MFX (cell-T group, n=7) or MFX alone (control group, n=4). Clinical results were evaluated using International Knee Documentation committee (IKDC) knee evaluation questionnaires and the Knee Injury and Osteoarthritis Outcome Score (KOOS) before and 48 weeks after surgery. Quantitative and qualitative assessments of repair tissue were carried out at 48 weeks by T2 mapping of magnetic resonance images (MRIs) and the magnetic resonance observation of cartilage repair tissue (MOCART) scoring system with follow-up MRI.

Results: No significant differences between preoperative and postoperative IKDC and KOOS were observed in the cell-T or control group. However, forty-eight weeks after surgery, the cell-T group showed a trend for a greater KOOS QOL score compared with the control group (79.4 vs. 39.1, respectively; P=0.07). The T2 value did not differ significantly between the two groups, but the mean MOCART score was significantly higher in the cell-T group than in the control group (P=0.02).

Conclusions: Compared with MFX alone, BMSC transplantation with MFX resulted in better postoperative healing of the cartilage and subchondral bone as determined by the MOCART score. Clinically, BMSC transplantation with MFX gave a higher KOOS QOL score after 48 weeks.

Keywords: BMSCs, bone marrow-derived mesenchymal stem cells; Bone marrow-derived mesenchymal stem cells; CPC, cell processing centers; GFP, green fluorescent protein; HA, hyaluronic acid; IKDC, International Knee Documentation committee; KL, Kellgren–Lawrence; KOOS, Knee Injury and Osteoarthritis Outcome Score; MFX, microfracture; MOCART, magnetic resonance observation of cartilage repair tissue; MRIs, magnetic resonance images; Microfracture; Prospective randomized control clinical trial; QOL, quality of life; RCT, randomized controlled trial.

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Figures

Fig. 1
Fig. 1
Arthroscopic view and photograph of injection. a Microfracture for cartilage defect of lateral tibia plateau. b Injection of autologous BMSCs under arthroscopy.
Fig. 2
Fig. 2
Flowchart of patients through the randomized controlled trial (RCT. BMSC, autologous bone marrow-derived mesenchymal stem cells; MFX, microfracture.
Fig. 3
Fig. 3
Pre and postoperative clinical scores. At 48 weeks after surgery, the KOOS QOL sub-score tended to be higher in the cell-T group than the control group (p = 0.07.
Fig. 4
Fig. 4
Pre and postoperative T2 values of repaired cartilage. There was no significant difference between the two groups in preoperative, 6, 24, and 48 weeks after surgery.
Fig. 5
Fig. 5
The mean MOCART score was significantly higher in the cell-T group than the control group (p = 0.02.
Fig. 6
Fig. 6
Pre and postoperative MRI. a The cartilage defect was seen at the lateral tibia plateau in the preoperative MRI of the cell-T group. b The cartilage was full covered, integration to the border zone was complete, and the MOCART score was 100 at 48 weeks after surgery. c The cartilage defect was seen at the medial femoral condyle in the preoperative MRI of the control group. d The filling of the defect was incomplete, the repair tissue surface was damaged, the subchondral bone was not intact, and the MOCART score was 40 at 48 weeks after surgery.
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