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Review
. 2020 Apr 27:24:121-130.
doi: 10.1016/j.jot.2020.03.015. eCollection 2020 Sep.

Mesenchymal stem cells in knee osteoarthritis treatment: A systematic review and meta-analysis

Yancheng Song  1 , Junhui Zhang  1 , Hualiang Xu  1 , Zhujian Lin  1 , Hong Chang  1 , Wei Liu  1 , Ling Kong  2
Affiliations
Review

Mesenchymal stem cells in knee osteoarthritis treatment: A systematic review and meta-analysis

Yancheng Song et al. J Orthop Translat. .

Abstract

Stem cells are considered to be one of the greatest potential treatments to cure degenerative diseases. Stem cells injection for knee osteoarthritis (OA) is still a relatively new treatment and has not yet gained popularity. So, the effectiveness, safety and potential of mesenchymal stem cells (MSCs) for knee OA treatment is worthy to be explored. Explore the effectiveness and safety of mesenchymal stem cells (MSCs) in the treatment of knee osteoarthritis. We collected clinical trials using MSCs as treatment for knee OA (before April 2019), including randomized controlled trials (RCTs), retrospective studies and cohort studies. We searched PubMed, EMBASE, Cochrane Library, Web of Science and the ClinicalTrials.gov with keywords (Mesenchymal stem cells [MSCs], Knee osteoarthritis, Effectiveness and Safety), and then performed a systematic review and cumulative metaanalysis of all RCTs and retrospective comparative studies. To evaluate the effectiveness and safety of MSC in knee OA treatment, we applied visual analog scale score, Western Ontario and McMaster Universities Osteo-arthritis Index and adverse events. We included 15 RCTs, two retrospective studies and two cohort studies including a total of 584 knee OA patients in this study. We demonstrated that MSC treatment could significantly decrease visual analog scale in a 12-month follow-up study compared with controls (p < 0.001). MSC therapy also showed significant decreases in Western Ontario and McMaster Universities Osteoarthritis Index scores after the 6-month follow-up (p < 0.001). MSC therapy showed no difference compared with controls (p > 0.05) in adverse events. We suggest that MSC therapy could serve as an effective and safe therapy for clinical application in OA treatment.

The translational potential of this article: This study provided the best available evidence and a wider perspective to MSCs application in the management of knee OA. MSCs therapy will have great translational potential in the clinical treatment of various degenerative diseases once optimum formula and explicit target population are identified.

Keywords: Knee osteoarthritis; Mesenchymal stem cells; Meta-analysis.

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Conflict of interest statement

The authors have no conflicts of interest to disclose in relation to this article.

Figures

Figure 1
Figure 1
Flow diagram of studies identified, included and excluded. PRP = platelet-rich plasma.
Figure 2
Figure 2
Risk of bias graph—review authors' judgments about each risk of bias item presented.
Figure 3
Figure 3
Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score (6 months of MSCs and preoperative of MSCs). CI = confidence interval; MSCs = mesenchymal stem cells; SD = standard deviation; IV = Inverse Variance methods.
Figure 4
Figure 4
Visual analog scale (VAS) score (3–6–12 months of MSCs and preoperative of MSCs). CI = confidence interval; MSCs = mesenchymal stem cells; SD = standard deviation; IV = Inverse Variance methods.
Figure 5
Figure 5
Safety assessment (MSCs and control groups). CI = confidence interval; MSCs = mesenchymal stem cells; M-H (Mantel-Haenszel) = Statistical Method for Calculating Odds Ratio of Binary Variables.
Figure 6
Figure 6
WOMAC score of different cell origin (6 months of MSCs and preoperative of MSCs). CI = confidence interval; MSCs = mesenchymal stem cells; SD = standard deviation; IV = Inverse Variance methods.
Figure 7
Figure 7
WOMAC score of different number of cells (6 months of MSCs and preoperative of MSCs). CI = confidence interval; MSCs = mesenchymal stem cells; SD = standard deviation; IV = Inverse Variance methods.
Figure 8
Figure 8
Funnel plots illustrating meta-analysis of complication rates. OR = odds ratio; SE = standard error.
See this image and copyright information in PMC

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