Abstract
BackgroundSupramalleolar osteotomy (SMO) is reported to be an effective treatment for varus ankle osteoarthritis by redistributing the load line within the ankle joint. Mesenchymal stem cells (MSCs) have been proposed as a new treatment option for osteoarthritis on the basis of their cartilage regeneration ability. The purpose of this study was to compare the clinical, radiological, and second-look arthroscopic outcomes between MSC injection with marrow stimulation and marrow stimulation alone in patients with varus ankle osteoarthritis who have undergone SMO.MethodsIn this retrospective study, 62 patients (64 ankles) with varus ankle osteoarthritis underwent second-look arthroscopy at a mean of 12.8 months after arthroscopic marrow stimulation combined with SMO; 33 ankles were subjected to marrow stimulation alone (group I), and 31 were subjected to marrow stimulation with MSC injection (group II). Clinical outcome measures included a visual analog scale (VAS) for pain and the American Orthopaedic Foot and Ankle Society (AOFAS) score. Radiological outcome variables included the tibial–ankle surface (TAS), talar tilt (TT), and tibial–lateral surface (TLS) angles. In second-look arthroscopy, cartilage regeneration was evaluated using the International Cartilage Repair Society (ICRS) grade.ResultsThe mean VAS score improved significantly from 7.2 ± 1.0 to 4.7 ± 1.4 in group I and from 7.3 ± 0.8 to 3.7 ± 1.5 in group II at the final follow-up (P < 0.001 for both groups). The mean AOFAS score also improved significantly from 61.7 ± 5.8 to 80.9 ± 6.7 in group I and from 60.6 ± 6.1 to 85.2 ± 5.1 in group II at the final follow-up (P < 0.001 for both groups). There were significant differences in the mean VAS and AOFAS scores between groups at the final follow-up (P = 0.002 and 0.010, respectively). At second-look arthroscopy, there were significant differences in ICRS grades between groups(P = 0.015 for medial aspect of the talar dome, P = 0.044 for medial aspect of the tibial plafond, and P = 0.005 for articular surface of the medial malleolus). ICRS grades were significantly correlated with clinical outcomes in both groups (all P < 0.05). Mean TAS, TT, and TLS angles improved significantly after SMO in both groups but were not significantly correlated with clinical outcomes or ICRS grade (all n.s.).ConclusionsThe clinical and second-look arthroscopic outcomes of MSC injection with marrow stimulation were better compared to those of marrow stimulation alone in patients with varus ankle osteoarthritis who have undergone SMO. Furthermore, the ICRS grade is significantly correlated with clinical outcome.
Highlights
Supramalleolar osteotomy (SMO) is reported to be an effective treatment for varus ankle osteoarthritis by redistributing the load line within the ankle joint
The International Cartilage Repair Society (ICRS) grade is significantly correlated with clinical outcome
Isolation and characterization of Mesenchymal stem cells (MSCs) We evaluated the capacity of human subcutaneous adipose tissue to generate mesenchymal progenitors according to CFU-F
Summary
Supramalleolar osteotomy (SMO) is reported to be an effective treatment for varus ankle osteoarthritis by redistributing the load line within the ankle joint. Kim et al (Kim et al 2014b) performed arthroscopic marrow stimulation along with SMO in patients with varus ankle osteoarthritis and assessed cartilage regeneration after arthroscopic marrow stimulation using second-look arthroscopic evaluation; the cartilage regeneration of medial osteoarthritic lesions was significantly associated with the clinical outcomes of SMO. Marrow stimulation treatment primarily aims to recruit mesenchymal stem cells (MSCs) from bone marrow, which leads to coverage of the lesion with fibrous cartilage (Giannini et al 2009; Hangody et al 2001; Kono et al 2006) This treatment provides acceptable clinical results over midterm follow-up periods but often fail in the long term because of biomechanical insufficiency of the regenerative fibrous cartilage and scar tissue that results from this method (Baltzer and Arnold 2005). MSCs were recently proposed as a new treatment option for osteoarthritis on the basis of their ability to differentiate into chondrocytes as well as the paracrine effects of their secreted bioactive materials (Barry and Murphy 2013; Beris et al 2005; Caplan and Dennis 2006; Galois et al 2005; Oreffo et al 2005)
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