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: http://creativecommons.org/licenses/by-nc/4.0/
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. peter@catholic.ac.kr
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
Processing time: 125 Days and 2.7 Hours
Abstract
BACKGROUND

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.

AIM

To evaluate cartilage regeneration after implantation of allogenic human umbilical cord blood-derived mesenchymal stem cells (hUCB-MSCs) with concomitant HTO.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Keywords: Allogeneic; Human umbilical cord blood-derived mesenchymal stem cells; Cartilage regeneration; High tibial osteotomy; Osteoarthritic knees; Arthroscopy

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.