A New Advanced Osteoarthritis Treatment Utilizing Modified Mesenchymal Stem Cells: Arthroscopic Guided Intra-Articular Intervention Approach a Systematic Review and Meta-Analysis

medRxiv - Orthopedics Pub Date : 2023-12-21 DOI:10.1101/2023.12.18.23299488

Kevin Christian Tjandra, Robin Novriansyah, I Nyoman Sebastian Sudiasa, Ardiyana Ar, Nurul Azizah Dian Rahmawati, Ismail Hadisoebroto Dilogo

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Abstract

Background Mesenchymal stem cells (MSCs) can help repair damaged cartilage in osteoarthritis (OA) and prevent disability. Combining MSCs with platelet-rich plasma (PRP) and hyaluronic acid (HA) might make this treatment more effective. This study aims to find out how well MSCs, PRP, and different HA doses work together, what's the best source of MSCs, and how many MSCs to use for treating osteoarthritis and regenerating cartilage. Method The sources included were original articles published from 2013 until 2023 from 4 databases. Studies included were original research of clinical trials or randomized controlled trials. Irrelevant studies were excluded. Then, the ROB-2 taken was used to assess bias. The result was constructed with PICOS criteria table. MRI score, VAS score, Lysholm score, Cartilage volume, size of cartilage defect, Knee Society Clinical Rating System Score (KSS), and WOMAC index to evaluate treatment’s effication outcomes were analyzed by Revman 5.4. This systematic review followed the PRISMA guidelines. Result nine studies were included in the final screening. The meta-analysis showed a significant (P < 0.00001) elevation of Lysholm score with a pooled mean difference (MD) of (17.89) (95% CI: 16.01, 19.77; I2 = 0%, P = 0.56); a significant reduction (P < 0.00001) of VAS score with a pooled MD of (-2.62) (95% CI: -2.83, -2.41; I2 = 99%, P <0.00001); Knee society clinical rating system score (KSS) evaluation also showed significant elevation (P< 0.00001) with mean polled (29.59) (95% CI: 27.66, 31.52; I2= 95%, P< 0.0001); and significantly reduction (P< 0.00001) of WOMAC score occurred as pooled MD of (-12.38) (95% CI: -13.75, -11.01; I2= 99%, P< 0.0001). Conclusions Arthroscopic guided high-dose subchondral application of primary cultured synovial mesenchymal stem cells in popliteal platelet-rich plasma media combined with hyaluronic acid effectively regenerate cartilage defect and increase clinical outcomes in the early stage of osteoarthritis.

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利用改良间充质干细胞的新型高级骨关节炎治疗方法：关节镜引导下的关节内介入方法系统回顾与元分析

背景间充质干细胞（MSCs）有助于修复骨关节炎（OA）中受损的软骨，防止残疾。将间叶干细胞与富血小板血浆（PRP）和透明质酸（HA）结合使用可能会使这种治疗方法更加有效。本研究旨在了解间充质干细胞、富血小板血浆和不同剂量的透明质酸的协同作用效果如何，间充质干细胞的最佳来源是什么，以及使用多少间充质干细胞治疗骨关节炎和软骨再生。方法从4个数据库中选取2013年至2023年发表的原创文章作为研究来源。纳入的研究均为临床试验或随机对照试验的原始研究。排除了不相关的研究。然后，使用 ROB-2 评估偏倚。结果根据 PICOS 标准表得出。MRI 评分、VAS 评分、Lysholm 评分、软骨体积、软骨缺损大小、膝关节学会临床评分系统评分（KSS）和 WOMAC 指数通过 Revman 5.4 进行分析，以评估治疗效果。该系统性综述遵循了 PRISMA 指南。最终筛选出九项研究。荟萃分析结果显示，Lysholm 评分显著升高（P< 0.00001），汇总平均差（MD）为（17.89）（95% CI：16.01, 19.77；I2 = 0%，P = 0.56）；VAS 评分显著降低（P< 0.00001），汇总平均差（MD）为（-2.62）（95% CI：-2.83, -2.41；I2 = 99%，P<0.00001）；膝关节社会临床评分系统评分（KSS）评估也显示出显著的升高（P< 0.00001），平均值为（29.59）（95% CI：27.66，31.52；I2= 95%，P< 0.0001）；WOMAC 评分显著降低（P< 0.00001），汇总 MD 为（-12.38）（95% CI：-13.75，-11.01；I2= 99%，P< 0.0001）。结论在关节镜引导下，腘窝富血小板血浆培养基中的原代培养滑膜间充质干细胞结合透明质酸的高剂量软骨下应用可有效再生软骨缺损，提高骨关节炎早期的临床疗效。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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medRxiv - Orthopedics

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