252 / 460
Cell-based therapy in articular cartilage lesions of the knee
251
outcome between the groups in this relatively
short-term followup study, although there was
better arthroscopic and histological score
obtained by the MSCI group. There was no
randomization process in this study and the
followup period was short (less than two years
in average). The other study prospectively
compared the patients with ACI versus bone
marrow derived stem cell therapy in chondral
lesions. Two year followup resulted in no
significant difference detected in terms of
clinical scores (IKDC, Lysholm, Tegnar and
SF36) or of histological evaluation [22]. The
authors claimed that bone marrow derived stem
cell therapy could be an alternative to ACI with
potential advantage of less invasiveness
(avoidance of repetitive surgery) and of cost
effectiveness. Future accumulation of the
results of more comparative studies will be
required to evaluate the significance of stem
cell therapies targeting chondral lesions.
Literature review so far provides no evidence
for biological regeneration of hyaline cartilage
by any intervention in animal experiments and
current available therapies for cartilage
resurfacing are still far from regenerative, and
rarely restore full function. Therefore, we still
need to wait for future advances in the
understanding of the biology of cartilage and
stem cells, and further technological
advancements in therapeutic development.
The limitation of this study was the lack of
quantitative evaluation of the quality of the
papers. Due to the limited number of the studies
included, we only evaluated the studies by the
JBJS rating system. Further accumulations of
the publications would enablemore quantitative
evaluation of the treatment effects. Finally, the
relevanceof articular cartilage repair procedures
should be in the long term (10-20 years) and
not the short
term.Wedo not have any evidence-
based studies on cell-based therapy for articular
cartilage lesions for very long-term outcomes.
Further longer-term follow-up is needed in
relation to the preventive effect from the
progression in osteoarthritis.
Literature
[1] Buckwalter JA. Articular cartilage injuries.
Clin
Orthop Relat Res. 2002;402: 21-37.
[2] Hunziker EB. Articular cartilage repair: basic science
and clinical progress. A review of the current status and
prospects.
Osteoarthritis Cartilage. 2002;10: 432-63.
[3] BrittbergM, LindahlA, NilssonA, Ohlsson
C, Isaksson O, Peterson L. Treatment of deep
cartilage defects in the knee with autologous chondrocyte
transplantation.
New England Journal of Medicine 1994;
331(14):889-95.
[4] Hickery MS, Bayliss MT, Dudhia J,
Lewthwaite JC, Edwards JC, Pitsillides AA.
Age-related changes in the response of human articular
cartilage to IL-1alpha and transforming growth factor-beta
(TGF-beta): chondrocytes exhibit a diminished sensitivity to
TGF-beta.
J Biol Chem. 2003; 278: 53063-71.
[5] PittengerMF, MackayAM, Beck SC, Jaiswal
RK, Douglas R, Mosca JD,
et al.
Multilineage
potential of adult human mesenchymal stem cells.
Science.
1999;284: 143-7.
[6] Wasiak J, Clar C, Villanueva, E.
Autologous cartilage implantation for full thickness
articular cartilage defects of the knee.
Cochrane Database
Syst Rev. 2006 ;3 :CD003323 16856003.
[7] Schulz KF, Chalmers I, Hayes RJ, Altman
DG. Empiral evidence of bias. Dimensions of methodological
quality associated with estimates of treatment effects in
controlled trials.
JAMA 1995; 273(5): 408-12.
[8] Nakamura N, Miyama T, Engebretsen L,
Yoshikawa H, Shino K. Systematic Review. Cell-
Based Therapy in Articular Cartilage Lesions of the Knee.
Arthroscopy, 2009, 25: 531-52.
[9] Bentley G, Biant LC, Carrington RW,
Akmal M, Goldberg A, Williams AM, Skinner
JA, Pringle J. A prospective, randomised comparison of
autologous chondrocyte implantation versus mosaicplasty
for osteochondral defects in the knee.
J Bone Joint Surg Br.
2003 85:223-30.
[10] Knutsen G, Engebretsen L, Ludvigsen TC,
Drogset JO, Grontvedt T, Solheim E, Strand
T, Roberts S, Isaksen V, Johansen O. Autologous
chondrocyte implantation compared with microfracture in
the knee. A randomized trial.
J Bone Joint Surg Am. 2004
86-A: 455-64.