High tibial osteotomy with human umbilical cord blood-derived mesenchymal stem cells implantation for knee cartilage regeneration

Table 1 Patient demographic data

Patients	n = 125
Age, yr	58.3 ± 6.8
Sex, female/male	95 (76%)/30 (24%)
Lesion size, cm2	6.9 ± 2
HKA angle, degree	7.6 ± 2.4
Trochlear lesion
With lesion	73
Without lesion	52
Second look arthroscopic findings
ICRS grade I	73
ICRS grade II	37
ICRS grade III	15

HKA: Hip-knee-ankle; ICRS: International Cartilage Repair Society.

Table 2 Clinical outcomes according to the International Cartilage Repair Society grading system

	ICRS grade I (n = 73)	ICRS grade II (n = 37)	ICRS grade III (n = 15)	P value1	Post hoc5
IKDC
Preoperative	28.4 ± 7.4	30.1 ± 7.2	29.2 ± 8.1	0.610
1 yr	59.3 ± 8.7	52.4 ± 10.7	54.8 ± 7.1	0.005	I > II = III,I = III
2 yr	64.3 ± 9.2	58.6 ± 11.1	55.0 ± 8.0	< 0.001	I > II = III
3 yr	68.1 ± 10.8	61.0 ± 11.3	59.3 ± 5.8	< 0.001	I > II = III
P value2	< 0.001	< 0.001	0.001
P value3	< 0.001	< 0.001	0.842
P value4	0.001	0.063	0.047
WOMAC
Preoperative	45.1 ± 11	41.9 ± 9.2	44.3 ± 12.2	0.275
1 yr	11.0 ± 6.9	16.8 ± 8.5	17.6 ± 5.1	< 0.001	I > II = III
2 yr	8.4 ± 6.0	13.4 ± 8.2	17.3 ± 7.4	< 0.001	I > II = III
3 yr	6.5 ± 6.0	10.5 ± 5.6	12.6 ± 8.3	< 0.001	I > II = III
P value2	< 0.001	< 0.001	0.001
P value3	< 0.001	0.001	0.607
P value4	0.003	0.002	0.018
VAS
Preoperative	7.6 ± 1.4	7.5 ± 1.1	7.7 ± 0.8	0.817
1 yr	2.1 ± 1.7	3.0 ± 1.6	3.3 ± 1.2	0.002	I > II = III
2 yr	1.5 ± 1.4	2.7 ± 1.8	3.1 ± 1.2	< 0.001	I > II = III
3 yr	1.1 ± 1.5	2.0 ± 1.4	2.6 ± 0.9	< 0.001	I > II = III
P value2	< 0.001	< 0.001	0.001
P value3	< 0.001	0.229	0.658
P value4	0.004	0.019	0.103

Boldface indicates statistical significance (P < 0.05).

¹Kruskal-Wallis test.

²Wilcoxon signed-rank test: Preoperative vs 1 year postoperatively.

³Wilcoxon signed-rank test: 1 year postoperatively vs 2 years postoperatively.

⁴Wilcoxon signed-rank test: 2 years postoperatively vs 3 years postoperatively.

⁵Bonferroni adjustment using the Mann-Whitney U test. ICRS: International Cartilage Repair Society; IKDC: International Knee Documentation Committee; WOMAC: Western Ontario and McMaster Universities Osteoarthritis Index; VAS: Visual analog scales.

Table 3 Clinical outcomes according to trochlear lesion

	Trochlear lesion (n = 73)	No trochlear lesion (n = 52)	P value1
IKDC
Preoperative	29.3 ± 7.3	28.5 ± 7.6	0.794
1 yr	56.7 ± 9.7	56.7 ± 9.7	0.960
2 yr	61.6 ± 10.7	61.4 ± 9.5	0.916
3 yr	64.7 ± 11	65.3 ± 11.4	0.493
WOMAC
Preoperative	44.8 ± 10.3	43.1 ± 11.1	0.288
1 yr	13.8 ± 7.5	13.2 ± 8.2	0.471
2 yr	10.7 ± 6.9	11.3 ± 8.5	0.958
3 yr	8.4 ± 6.4	8.4 ± 6.8	0.755
VAS
Preoperative	7.8 ± 1.2	7.3 ± 1.3	0.046
1 yr	2.6 ± 1.7	2.3 ± 1.6	0.331
2 yr	2.1 ± 1.5	2.0 ± 1.7	0.555
3 yr	1.6 ± 1.4	1.4 ± 1.6	0.203

Boldface indicates statistical significance (P < 0.05).

¹Mann-Whitney U test. IKDC: International Knee Documentation Committee; WOMAC: Western Ontario and McMaster Universities Osteoarthritis Index; VAS: Visual analog scales.

Table 4 Effect of age and lesion size on clinical outcomes

	Age (n = 125)				Lesion size (n = 125)
	β	t	R2	P value1	β	t	R2	P value1
IKDC
Pre-op	-0.128	-1.429	0.016	0.156	-0.148	-1.661	0.022	0.099
1 yr	-0.095	-1.053	0.009	0.294	-0.025	-0.282	0.001	0.779
2 yr	-0.053	-0.593	0.003	0.554	-0.120	-1.339	0.014	0.183
3 yr	0.049	0.549	0.002	0.584	0.024	0.266	0.001	0.791
WOMAC
Pre-op	0.327	3.831	0.107	< 0.001	0.305	3.550	0.093	0.001
1 yr	0.173	1.945	0.030	0.054	0.040	0.440	0.002	0.661
2 yr	-0.005	-0.055	< 0.001	0.956	0.052	0.575	0.003	0.566
3 yr	-0.048	-0.532	0.002	0.595	-0.064	-0.716	0.004	0.475
VAS
Pre-op	0.115	1.286	0.013	0.201	0.335	3.943	0.112	< 0.001
1 yr	0.114	1.278	0.013	0.204	0.113	1.266	0.013	0.208
2 yr	0.001	0.013	<0.001	0.989	0.112	1.249	0.013	0.214
3 yr	-0.047	-0.519	0.002	0.605	0.164	1.842	0.027	0.068

Boldface indicates statistical significance (P < 0.05).

¹Simple regression analysis. Pre-op: Preoperative; IKDC: International Knee Documentation Committee; WOMAC: Western Ontario and McMaster Universities Osteoarthritis Index; VAS: Visual analog scales.