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While performing HTO
for varus knee OA, the use of MSC injection should be considered as an
additional procedure as it significantly improves clinical outcomes.
According to
scientists of Yonsei Sarang Hospital (Orthopaedic Surgery department) research,
injecting mesenchymal stem cells along with high tibial osteotomy provides
additional support in cartilage
regeneration among patients with knee osteoarthritis. High tibial osteotomy
(HTO) used to treat knee osteoarthritis effectively via re-positioned the load
line inside the knee joint. On the other hand, mesenchymal stem cells (MSCs)
via cell-based tissue engineering system helps to repair articular cartilage of
the knee.
Now, the question is
what happens if both techniques combined to treat knee OA?
To find the answer,
Yong Sang Kim and Yong Gon Koh evaluate radiological, second-look arthroscopic
and clinical outcomes of HTO versus with or without MSC injections by
conducting a cohort study. The study also involved the determination of a
relationship between HTO and cartilage regeneration. A total of 270 patients
who went through HTO from September 2009 to April 2014 were selected. A
comparative matched-pair analysis based on age, lesion size and sex was
conducted between the Conventional group (received treat with the only HTO) and
Injection group (received HTO with MSC injection). The Posterior tibial slope
and Femorotibial angle were used to measure radiological and Lysholm along with
Knee Documentation Committee (IKDC) scores for clinical outcomes. The
International Cartilage Repair Society (ICRS) grade was used to measure
cartilage regeneration during the second-look arthroscopic surgery.
Both groups
exhibited improved mean Lysholm and IKDC scores at the time of second-look
arthroscopic surgery. However, at final follow up only the injection group
exhibited increased Lysholm and IKDC scores. The conventional and injection
group presented a significantly different mean Lysholm and IKDC at the final
follow-up. The injection group also exhibited better ICRS scores and an
association of ICRS with clinical outcomes. Patients also showed improved
radiological scores at final follow-up but showed no association with ICRS or
clinical outcomes. As per findings, an injection of MSC appears to be very
beneficial when given along with HTO approach.
Am J Sports Med
Comparative Matched-Pair Analysis of Open-Wedge High Tibial Osteotomy With Versus Without an Injection of Adipose-Derived Mesenchymal Stem Cells for Varus Knee Osteoarthritis: Clinical and Second-Look Arthroscopic Results
Yong Sang Kim, Yong Gon Koh
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