Journal of Cartilage & Joint Preservation (Dec 2023)

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

  • Zachariah Gene Wing Ow,
  • Katelyn Kaye-Ling Lim,
  • Shant Qinxiang Sin,
  • Hannah Li Xin Cheang,
  • Dean Wang,
  • Denny Tjiauw Tjoen Lie,
  • James Hoi Po Hui,
  • Keng Lin Wong

Journal volume & issue
Vol. 3, no. 4
p. 100128

Abstract

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ABSTRACT: 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.

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