Abstract
Current clinical applications of mesenchymal stem cell therapy for osteoarthritis lack consistency because there are no established criteria for clinical processes. We aimed to systematically organize stem cell treatment methods by reviewing the literature. The treatment methods used in 27 clinical trials were examined and reviewed. The clinical processes were separated into seven categories: cell donor, cell source, cell preparation, delivery methods, lesion preparation, concomitant procedures, and evaluation. Stem cell donors were sub-classified as autologous and allogeneic, and stem cell sources included bone marrow, adipose tissue, peripheral blood, synovium, placenta, and umbilical cord. Mesenchymal stem cells can be prepared by the expansion or isolation process and attached directly to cartilage defects using matrices or injected into joints under arthroscopic observation. The lesion preparation category can be divided into three subcategories: chondroplasty, microfracture, and subchondral drilling. The concomitant procedure category describes adjuvant surgery, such as high tibial osteotomy. Classification codes were assigned for each subcategory to provide a useful and convenient method for organizing documents associated with stem cell treatment. This classification system will help researchers choose more unified treatment methods, which will facilitate the efficient comparison and verification of future clinical outcomes of stem cell therapy for osteoarthritis.
Highlights
Degenerative osteoarthritis (OA) is a common health concern worldwide
To evaluate the safety and efficacy of mesenchymal stem cells (MSCs) treatment, all patients were followed up for a minimum of 12 months in the clinical trials reviewed in this study
It has been shown that most clinical trials reviewed in this study employed clinical and radiologic outcome evaluations
Summary
Degenerative osteoarthritis (OA) is a common health concern worldwide. It is a major cause of disability that can negatively affect the physical and mental well-being of the patient [1]. The prevalence of degenerative OA increases, and the corresponding social costs will be a problem. The importance of treatment for middle-aged patients (50–60 years old) has been emphasized by the corresponding average life expectancy exceeding 80 years. There are various underlying mechanical and biochemical factors that cause OA [3]. Abnormal loading due to obesity, malalignment or instability of the joints, trauma, and excessive use have been considered as risk factors for the development of degenerative OA [4,5]. Abnormal physical forces on articular chondrocytes interrupt their metabolic processes and promote hypertrophy of chondrocytes, which leads to the undesirable production of proteolytic enzymes such as matrix metalloproteinase 13 (MMP13) [6,7]
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