Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Stem Cells. Jun 26, 2020; 12(6): 514-526
Published online Jun 26, 2020. doi: 10.4252/wjsc.v12.i6.514
High tibial osteotomy with human umbilical cord blood-derived mesenchymal stem cells implantation for knee cartilage regeneration
Jun-Seob Song, Ki-Taek Hong, Chae-Gwan Kong, Na-Min Kim, Jae-Yub Jung, Han-Soo Park, Young Ju Kim, Ki Bong Chang, Seok Jung Kim
Jun-Seob Song, Ki-Taek Hong, Na-Min Kim, Jae-Yub Jung, Han-Soo Park, Department of Orthopedic Surgery, Gangnam JS Hospital, Seoul 06053, South Korea
Chae-Gwan Kong, Ki Bong Chang, Seok Jung Kim, Department of Orthopedic Surgery, College of Medicine, The Catholic University of Korea, Uijeongbu-si 11765, South Korea
Young Ju Kim, Department of Nursing Education & Administration, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, Uijeongbu-si 11765, South Korea
Author contributions: Song JS performed the surgeries; Hong KT performed radiological evaluation; Kim NM, Jung JY, and Park HS analyzed the data; Kim YJ performed statistical analysis; Kong CG and Chang KB contributed to the conception of the study and search of the background literature; Kim SJ designed the study and wrote the manuscript.
Institutional review board statement: This study was reviewed and approved by the institutional review board of the Korea Ministry of Health and Welfare (2019-3100-003). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent statement: Informed consent was obtained from all individual participants included in the study.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: All data included in the manuscript are available upon request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Seok Jung Kim, MD, PhD, FRCS, Director, Professor, Surgeon, Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 271, Cheonbo-ro, Uijeongbu-si 11765, Gyeonggi-do, South Korea.
Received: February 21, 2020
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
Research background

High tibial osteotomy (HTO) is widely used to treat medial compartment osteoarthritis (MCOA) of the knee with varus deformity. HTO reduces knee pain and improves knee function by decreasing the pressure in the medial compartment of the knee.

Research motivation

HTO alone offers excellent short- and mid-term outcomes; however, these outcomes tend to deteriorate over time. For further improvement in knee joint condition, cartilage regeneration can be combined with HTO. Autologous chondrocyte implantation (ACI), osteochondral autologous transplantation (OAT), and microfracture have been known to be effective therapies for articular cartilage regeneration, but they are not suitable in case of osteoarthritis (OA) therapy. Recently, mesenchymal stem cells (MSCs) have been identified as a new option in the field of cartilage regeneration for the treatment of OA patients. The MSCs isolated from human umbilical cord blood (hUCB-MSCs) demonstrate higher proliferation and chondrogenic capacity than other MSCs. Reports on the clinical application of hUCB-MSCs are scarce, and there are no studies examining the use of hUCB-MSCs with concomitant HTO.

Research objectives

This study aimed to evaluate clinical outcomes and cartilage regeneration via second-look arthroscopy after implantation of hUCB-MSCs with concomitant HTO, for treatment of osteoarthritic knee with varus deformity.

Research methods

A total of 125 patients were included in this study with an average age of 58.3 ± 6.8 years (range: 43-74 years). All the patients 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, patient age, and lesion size, using the patients’ medical records.

Research results

The results obtained in this study show that cartilage was regenerated to ICRS grade III or better in all the cases after implantation of hUCB-MSCs with concomitant HTO. Regenerated cartilage in the ICRS grades I, II, and III groups improved the clinical outcomes of these patients. The ICRS grade I group showed the best clinical outcomes among the three groups. Indeed, all the scores in the ICRS grade I group improved over time compared with those of the ICRS grade II and III groups. Although some patients presented with partially regenerated cartilage, none of the patients showed lack of cartilage regeneration (ICRS grade IV).

Research conclusions

Our results show that implantation of hUCB-MSCs with concomitant HTO is an effective treatment option for patients with medial compartment osteoarthritis (MCOA). In addition, our results also suggest that the presence of trochlear or large cartilage lesions, or advanced age of the patient, does not significantly affect clinical outcomes in patients with MCOA undergoing HTO with hUCB-MSC implantation.