High tibial osteotomy with mesenchymal stem cells may improve outcomes, joint space width
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Published results showed patients undergoing high tibial osteotomy combined with a human umbilical cord blood-derived mesenchymal stem cell cartilage regeneration procedure may experience improved clinical outcomes and joint space width.
Researchers categorized 100 patients with International Cartilage Regeneration and Joint Preservation Society grade IV cartilage defects of more than 200 mm2 on the medial femoral condyle into two groups based on whether they underwent high tibial osteotomy (HTO) combined with either a human umbilical cord blood-derived mesenchymal stem cell-induced cartilage regeneration procedure (n=43) or microfracture (n=57). Researchers evaluated Hospital for Special Surgery, IKDC and Lysholm scores at 18 months postoperatively, as well as mechanical axis and joint space width.
Results showed patients who underwent HTO with mesenchymal stem cells had a better IKDC score vs. patients who underwent HTO and microfracture. Researchers also found a statistically significant difference in the joint space width increment between the two groups, in favor of patients in the mesenchymal stem cell group. Researchers noted no development of nonunion, correction loss or arthroplasty conversion in either group.
Perspective
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Orthopedic clinicians in the United States watch with jealous interest as our colleagues in Southeast Asia practice medicine with progenitor/stem cell therapies. Appropriate regulatory/developmental steps impede our ability to shoot from the hip with cell therapies and our cartilage practices. South Korea has taken a progressive stance and, consequently, they lead in this space.
Dong Won Suh, MD, and colleagues’ case-control study, out of Gyeonggi-do, South Korea, shows gains in joint space when combining high tibial osteotomy with a progenitor/stem cell cartilage repair technique, superior to high tibial osteotomy combined with microfracture alone. Their cell technique involved umbilical cord-derived cells in a hyaluronic acid hydrogel.
They are not the first out of their country nor world region to present a progenitor/stem cell cartilage repair technique combined with high tibial osteotomy. Yong Sang Kim, MD, Yong Gon Koh, MD, and colleagues in Seoul presented a convincing randomized controlled trial in Knee Surgery, Sports Traumatology, Arthroscopy in 2020 and a cohort study in the American Journal of Sports Medicine in 2018, both involving progenitor cells isolated from adipose via a collagenase. Similarly, Khay-Yong Saw, MChOrth, FRCS(Edin), and colleagues in Kuala Lumpur, Malaysia, have presented a technique with persuasive histology involving filgrastim-mobilized, apheresis-harvested cells in Arthroscopy in 2015.
It is not surprising that combining a progenitor/stem cell cartilage repair technique with a malalignment correction is more powerful than either alone. While the United States awaits the former, it will continue to awaken to the latter.
References:
Kim YS, et al. Am J Sports Med. 2018;doi:10.1177/0363546518785973.
Kim YS, et al. Knee Surg Sports Traumatol Arthrosc. 2020;doi:10.1007/s00167-019-05729-3.
Saw KY, et al. Arthroscopy. 2015;doi:10.1016/j.arthro.2015.03.038.
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