Good mid-term outcomes after adipose-derived culture-expanded mesenchymal stem cells implantation in knee focal cartilage defects

Abstract

Purpose The purpose of the present study was to investigate the mid‐term outcomes of a single‐stage cell‐based procedure in patients with knee focal symptomatic cartilage defects using matrix‐induced culture‐expanded autologous AD‐MSCs. It was hypothesised that the increased number of autologous AD‐MSCs after culture expansion is a safe and efficient cartilage repair procedure, which improves overtime chondrogenesis in cartilage lesions Methods Twenty‐five consecutive patients treated for a symptomatic cartilage defect were prospectively followed for 3 years. The median age of patients was 30.5 (range 16–43) with a median BMI of 23.6 kg/m2 (range 19–29) and an average size of the lesion of 3.5 cm2 (range 2–6). All patients underwent a single‐stage procedure consisting in filling each defect with autologous culture‐expanded mesenchymal stem cells embedded in a trimmed‐to‐fit commercially available biodegradable matrix. Pre‐operative and post‐operative evaluation included knee‐related clinical and functional evaluation based on objective and subjective scores at 6, 12, 24 and 36 months and MRI evaluation of the repair tissue using the MOCART score at 12 and 24 months. Results Clinical outcomes recorded significant improvements (p < 0.05) at the final follow‐up compared with baseline as following: all subcategories of KOOS Score, the IKDC subjective from 40.9 (range 20.7–65.6) to 76.9 (range 42–90.3), Tegner Activity Score from 3 (range 2–4) to 4 (range 3–4), VAS for pain from 6 (range 4–8) to 1 (range 0–3). All patients improve significantly their IKDC objective scores. The MRI findings showed complete filling of the defect and integration to the border zone for 65% of the patients. Two patients underwent post‐operative biopsies and the histological analysis demonstrated the presence of hyaline‐like tissue. Conclusions Adipose‐derived culture‐expanded mesenchymal stem cells were shown to be an efficient and safe single‐stage cell‐based procedure for symptomatic, full‐thickness knee chondral lesions. The findings of the present study demonstrate that all patients presented significant mid‐term clinical, functional and radiological improvement. Level of evidence IV.

Operative Knorpeltherapie aktuell

“…Weitere wissenschaftliche Untersuchungen zeigten, dass nasale Chondrozyten [111] und mesenchymale Stammzellen [112] zukunftsfähige Optionen in der Behandlung fokaler Knorpelschäden darstellen können.…”

Recent advances and future trends in articular cartilage repair

“…Kyriakidis et al [68] (2020) published the mid-term results of a case series treated using matrix induced culture expanded adipose tissue derived MSCs embedded in a trimmedto-fit commercially available biodegradable matrix for the treatment of the focal chondral lesions. Twenty-five consecutive patients with an average lesion size of 3.5 cm 2 (range 2-6) and median age of 30.5 (range 16-43) showed significant improvements in the clinical scores at a mean 3 years follow-up.…”

“…Future expectations will be a combination of the morphological and quantitative MRI that can give the clinician a detailed structural and biochemical information about the repaired cartilage. [82] Various studies have compared the results of different procedures such as MF, [7] AMIC, [49] OCT, [83] MACI, [32,33] and ADSCs [68] with the post-operative MRI using either the morphological or the biochemical studies; the comparison being mostly consistent but not always. On the other hand, studies like that of Årøen et al [84] were able to demonstrate the sensitivity of MRI in delineating the quality of cartilage surrounding a focal defect using the T2 mapping and dGEMRIC studies.…”

Is Extracellular Vesicle-Based Therapy the Next Answer for Cartilage Regeneration?

“…Numerous tissue engineering approaches have been developed by using biomaterials as ECM derivatives or mesenchymal stem cells (MSCs) as chondrogenic precursors to alleviate the lack of accessibility for primary chondrocytes (Bakhshayesh et al, 2020;Tsiapalis and O'Driscoll, 2020). Because of their promising results in vitro or on animal models, these approaches are currently investigated to be transferred to clinic practice (Borić et al, 2019;Kim et al, 2020;Kyriakidis et al, 2020;Lehoczky et al, 2020;Mendes et al, 2020). Cell therapy approaches involving patients are also encouraging, and many clinical trials are ongoing.…”