Published online Jun 26, 2020. doi: 10.4252/wjsc.v12.i6.514
Peer-review started: February 21, 2020
First decision: March 30, 2020
Revised: April 24, 2020
Accepted: May 12, 2020
Article in press: May 12, 2020
Published online: June 26, 2020
High tibial osteotomy (HTO) is a well-established method for the treatment of medial compartment osteoarthritis of the knee with varus deformity. However, HTO alone cannot adequately repair the arthritic joint, necessitating cartilage regeneration therapy. Cartilage regeneration procedures with concomitant HTO are used to improve the clinical outcome in patients with varus deformity.
To evaluate cartilage regeneration after implantation of allogenic human umbilical cord blood-derived mesenchymal stem cells (hUCB-MSCs) with concomitant HTO.
Data for patients who underwent implantation of hUCB-MSCs with concomitant HTO were evaluated. The patients included in this study were over 40 years old, had a varus deformity of more than 5°, and a full-thickness International Cartilage Repair Society (ICRS) grade IV articular cartilage lesion of more than 4 cm2 in the medial compartment of the knee. All patients underwent second-look arthroscopy during hardware removal. Cartilage regeneration was evaluated macroscopically using the ICRS grading system in second-look arthroscopy. We also assessed the effects of patient characteristics, such as trochlear lesions, age, and lesion size, using patient medical records.
A total of 125 patients were included in the study, with an average age of 58.3 ± 6.8 years (range: 43-74 years old); 95 (76%) were female and 30 (24%) were male. The average hip-knee-ankle (HKA) angle for measuring varus deformity was 7.6° ± 2.4° (range: 5.0-14.2°). In second-look arthroscopy, the status of medial femoral condyle (MFC) cartilage was as follows: 73 (58.4%) patients with ICRS grade I, 37 (29.6%) with ICRS grade II, and 15 (12%) with ICRS grade III. No patients were staged with ICRS grade IV. Additionally, the scores [except International Knee Documentation Committee (IKDC) at 1 year] of the ICRS grade I group improved more significantly than those of the ICRS grade II and III groups.
Implantation of hUCB-MSCs with concomitant HTO is an effective treatment for patients with medial compartment osteoarthritis and varus deformity. Regeneration of cartilage improves the clinical outcomes for the patients.
Core tip: This is the first study to evaluate clinical outcomes and cartilage regeneration via second-look arthroscopy after implantation of human umbilical cord blood-derived mesenchymal stem cells (hUCB-MSCs) with concomitant high tibial osteotomy (HTO) for treatment of osteoarthritic knee with varus deformity. HTO treatment of medial compartment osteoarthritis of the knee with varus deformity alone does not sufficiently repair arthritic joints. However, HTO decreases pressure in the medial compartment, providing an environment in which damaged cartilage can be regenerated via implantation of allogenic hUCB-MSCs. hUCB-MSC implantation with HTO is an effective treatment for patients with osteoarthritis of the knee with varus deformity, leading to improved clinical outcomes.