Bone marrow-derived mesenchymal stem cells may be safe, effective for chondral knee defects
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Published results showed bone marrow-derived mesenchymal stem cell implantation may be equally effective and safe as autologous chondrocyte implantation for the treatment of full-thickness cartilage defects of the knee.
Researchers assessed 72 patients who underwent either intra-articular autologous bone marrow-derived mesenchymal stem cell implantation or autologous chondrocyte implantation for treatment of full-thickness cartilage defects of the knee with SF-36 scores, the IKDC knee evaluation form, the Lysholm Knee Score and the Tegner Activity Scale. Researchers also obtained information on any additional surgical procedures and safety data, including infection and tumor formation.
After cartilage repair surgery, results showed improvements in all patient-reported outcome scores except for the mental component summary of the SF-36. Researchers found no significant difference between the bone marrow-derived mesenchymal stem cell group and the autologous chondrocyte implantation group in any of the patient-reported outcomes at any time point. Subsequent surgical procedures occurred in six patients in the autologous chondrocyte implantation group and in five patients in the bone marrow-derived mesenchymal stem cell group, according to results. Within the follow-up period, researchers noted no deep infections or tumors within either group.
“The ease of culture expansion as compared with chondrocytes may prove to be a decisive advantage in the older patient cohort as the age indications for these regenerative procedures continues to expand,” the authors wrote. “Moreover, [bone marrow-derived mesenchymal stem cells] BMSCs are relatively easy to isolate, with the advantage of avoiding a second surgical procedure and the associated donor site morbidity.” – by Casey Tingle
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Thomas Einhorn, MD
This is a promising study providing level 2 evidence that outcomes after implantation of bone marrow-derived mesenchymal stem cells are equivalent to those achieved with implantation of autologous chondrocytes in the treatment of chondral defects of the knee. These are potentially important findings as they support the concept that proliferative potential in the cells allows for differentiation into bone, as well as cartilage, and this may be useful in the treatment of osteochondral lesions. The cells are also easier to obtain than autologous chondrocytes, the number of procedures required to harvest the cells are reduced and there is less associated donor site morbidity.
Moreover, safety concerns have been raised concerning the potential for stem cells to induce tumor formation and this report shows no increase in tumor formation up to 10 years. In the absence of level 1 evidence derived from appropriately powered randomized trials, this type of information is encouraging.
NYU Langone Health
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