Systematic review assessing the evidence for the use of stem cells in fracture healing

Abstract

Aims Bone demonstrates good healing capacity, with a variety of strategies being utilized to enhance this healing. One potential strategy that has been suggested is the use of stem cells to accelerate healing. Methods The following databases were searched: MEDLINE, CENTRAL, EMBASE, Cochrane Database of Systematic Reviews, WHO-ICTRP, ClinicalTrials.gov, as well as reference checking of included studies. The inclusion criteria for the study were: population (any adults who have sustained a fracture, not including those with pre-existing bone defects); intervention (use of stem cells from any source in the fracture site by any mechanism); and control (fracture healing without the use of stem cells). Studies without a comparator were also included. The outcome was any reported outcomes. The study design was randomized controlled trials, non-randomized or observational studies, and case series. Results In all, 94 eligible studies were identified. The clinical and methodological aspects of the studies were too heterogeneous for a meta-analysis to be undertaken. A narrative synthesis examined study characteristics, stem cell methods (source, aspiration, concentration, and application) and outcomes. Conclusion Insufficient high-quality evidence is available to determine the efficacy of stem cells for fracture healing. The studies were heterogeneous in population, methods, and outcomes. Work to address these issues and establish standards for future research should be undertaken. Cite this article: Bone Joint Open 2020;1-10:628–638.

A comparative study of Elevation of depressed tibial plateau fracture (Schazer type 2 and 3) by Autograft and synthetic bone substitute

“…However, harvesting ABGs imparts additional morbidity. Furthermore, a recent systematic review concluded that, despite ongoing research, there is currently insufficient evidence to elucidate the utility of biologically active bone grafts in fracture healing [38] . Indeed, consensus indicates that synthetic bone grafts may provide viable alternative void filler in the setting of tibial plateau fractures [5,10,30,34,[39][40][41][42][43][44] .…”

Autologous versus synthetic bone grafts for the surgical management of tibial plateau fractures: a systematic review and meta-analysis of randomized controlled trials

“…45 Furthermore, a recent systematic review concluded that, despite ongoing research, there is currently insufficient evidence to elucidate the utility of biologically active bone grafts in fracture healing. 46 Indeed, consensus indicates that synthetic bone grafts may provide a viable alternative void filler in the setting of tibial plateau fractures. [31][32][33][34][35][36][37]40,[47][48][49] This meta-analysis represents the most contemporary synthesis of high-quality (Oxford Centre for Evidence-Based Medicine, OCEBM, Level 1), randomizedcontrolled literature comparing synthetic and autologous bone grafts for tibial plateau fractures, and supersedes a previous systematic review containing lower-level literature.…”

“… 45 Furthermore, a recent systematic review concluded that, despite ongoing research, there is currently insufficient evidence to elucidate the utility of biologically active bone grafts in fracture healing. 46 Indeed, consensus indicates that synthetic bone grafts may provide a viable alternative void filler in the setting of tibial plateau fractures. 31 - 37 , 40 , 47 - 49…”

Different Protocols of Combined Application of Photobiomodulation In Vitro and In Vivo Plus Adipose-Derived Stem Cells Improve the Healing of Bones in Critical Size Defects in Rat Models

“…Mott et al concluded that excellent proof to confirm the efficiency of MSCs for bone repair is nonexistent. 13 One strategy to increase MSC capability and function after transplantation in bone defects could be the use of photobiomodulation (PBM). Similarly acknowledged as low-level laser therapy, PBM is the usage of a laser to enhance curing, mitigate soreness, and decrease inflammation.…”