Mesenchymal Stem Cell Therapy in Chondral Defects of Knee: Current Concept Review
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REVIEW ARTICLE
Mesenchymal Stem Cell Therapy in Chondral Defects of Knee: Current Concept Review Ujjwal K. Debnath1 Received: 26 April 2020 / Accepted: 8 July 2020 © Indian Orthopaedics Association 2020
Abstract Purpose Full-thickness cartilage defects if left alone would increase the risk of osteoarthritis (OA) with severe associated pain and functional disability. Articular cartilage defect may result from direct trauma or chronic degeneration. The capability of the mesenchymal stem cells (MSCs) to repair and regenerate cartilage has been widely investigated. This review describes current trends in MSC biology, the sourcing, expansion, application and role of MSCs in chondral defects of human knees. Methods The studies referencing MSCs and knee osteoarthritis were searched (from1998 to 2020) using PubMed, EMBASE, Cochrane Library, Web of Science and the ClinicalTrials.gov with keywords (MSCs, chondral defects or cartilage degeneration of knee, cartilage regeneration, chondrogenesis, tissue engineering, efficacy and safety). The inclusion criteria were based on use of MSCs for treatment of chondral defects and osteoarthritis of the knee, English language and human studies. Results The history of MSC research from the initial discovery of their multipotency to the more recent recognition of their role in cartilage defects of knee is elucidated. Several studies have demonstrated promising results in the clinical application for repair of chondral defects as an adjuvant or independent procedure. Intra-articular MSCs provide improvements in pain and function in knee osteoarthritis at short-term follow-up in many studies. The tendency of MSCs to differentiate into fibrocartilage affecting the outcome is a common issue faced by researchers. Conclusion Some efficacy has been shown of MSCs for cartilage repair in osteoarthritis; however, the evidence of efficacy of intra-articular MSCs on both clinical outcomes and cartilage repair remains limited. Despite the high quality of evidence to support, MSC therapy has emerged but further refinement of methodology will be necessary to support its routine clinical use. Keywords Mesenchymal stem cells · Articular cartilage · Chondral defect · Knee osteoarthritis
Introduction Cartilage of each human joint is a highly specialized tissue acting as a shock absorber, enabling synovial joints to articulate with low frictional forces. It has limited repair potential since it is not vascular, nor it has lymphatics and is largely aneural [1]. Full-thickness cartilage defects if left alone would increase the risk of osteoarthritis (OA) with severe associated pain and functional disability. The capability of the mesenchymal stem cells (MSCs) to repair and regenerate various mesenchymal tissues in the human body has been widely researched including cartilage defect regeneration [2–6]. Over the past decade, an increase in the use
* Ujjwal K. Debnath [email protected] 1
Fortis Hospital, Anandapur, Kolkata 700107, India
of biological agents, including cell-based therapies, was ap
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