Similar short-term results between scaffold implanted mesenchymal stem cells vs acellular scaffolds with concentrated bone marrow aspirate augmentation for the repair of chondral defects of the knee: evidence from a meta-analysis

Background

Scaffold-implanted mesenchymal stem cells (MSCs) are gaining popularity for the treatment of cartilage defects. However, there is little evidence comparing its efficacy against the currently well-established technique of utilizing acellular scaffolds (ACs) with concentrated bone marrow aspirate (cBMA) for treating knee chondral defects.

Objectives

To compare scaffold-implanted MSCs against ACs with cBMA for the repair of knee cartilage lesions.

Data Sources

Medline and Embase.

Study Eligibility Criteria, Participants, and Interventions

Inclusion: (1) Studies involving patients with high grade chondral lesions on the tibiofemoral or patellofemoral articular surfaces, (2) studies involving patients that received either scaffold-implanted MSCs or ACs for treatment, and (3) studies with postoperative patient follow-up of at least 1 year.

Study Appraisal and Synthesis Methods

Single-arm meta-analysis of studies reporting patient-reported outcome measures, reoperation and incomplete filling rates was performed.

Results

Degree of postoperative International Knee Documentation Committee score improvement in patients receiving ACs augmented with cBMA was significantly higher compared to those receiving scaffold-implanted MSCs (P < .01). Additionally, patients receiving ACs with cBMA augmentation were at significantly lower risk of incomplete defect filling when compared to patients receiving either scaffold-implanted MSCs (P < .01), or patients receiving non-cBMA augmented ACs (P < .01).

Conclusion

This meta-analysis demonstrates that cartilage repair with ACs with cBMA augmentation yields marginally better short-term outcomes when compared to scaffold-implanted MSCs. This suggests that even with the advent of MSCs increasing in availability as a treatment modality, ACs with cBMA augmentation remains as a competitive, cost-effective option for cartilage repair.