Intra-articular injection of orthobiologics in patients undergoing high tibial osteotomy for knee osteoarthritis is safe and effective – a systematic review

Betzler, Brjan Kaiji; Bin Muhammad Ridzwan Chew, Aiman Haziq; Bin Abd Razak, Hamid Rahmatullah

doi:10.1186/s40634-021-00387-2

Journal of Experimental Orthopaedics

Table 5 Clinical outcomes of studies utilising injected mesenchymal stem cells

From: Intra-articular injection of orthobiologics in patients undergoing high tibial osteotomy for knee osteoarthritis is safe and effective – a systematic review

Study	Type of Osteotomy Performed	Intervention	Number of Patients in Intervention Group	Number of Patients in Control Group	Number of Patients undergoing second-look Arthroscopy	Pre-OP Lysholm Score	Post-OP Lysholm Score	Pre-OP IKDC Score	Post-OP IKDC Score	Pre-OP Tegner Activity Scale	Post-OP Tegner Activity Scale
Kim **et al, American Journal of Sports Medicine 2018** [23]	HTO	Adipose-derived MSCs	50	50	100/100 at mean 12.4 months (control) and 12.7 months (MSC)	Control (n = 50) v MSC (n = 50) 56.7 ± 12.2 v 55.7 ± 11.9	Control (n = 50) v MSC (n = 50) At final follow-up (mean 38.8 months (control) & 37.2 months (MSC)) 80.5 ± 15.2v 84.7 ± 16.1	Control (n = 50) v MSC (n = 50) 38.4 ± 9.2 v 36.5 ± 4.2	Control (n = 50) v MSC (n = 50) At final follow-up (mean 38.8 months (control) & 37.2 months (MSC)) 56.8 ± 14.7 v 64.8 ± 13.4	Not reported	Not reported
Koh **et al, Arthroscopy 2014** [21]	HTO	PRP with Adipose-derived MSCs	21	23	44/44 at mean 19.8 months post-op	PRP (control) (n = 23) v PRP-MSC (n = 21) 56.7 ± 12.2 v 55.7 ± 11.5	PRP (control) (n = 23) v PRP-MSC (n = 21) At latest follow-up (mean 24.6 months (PRP) and 24.2 months (PRP-MSC)) 80.6 ± 13.5 v 84.7 ± 16.2	Not Reported	Not Reported	Not Reported	Not Reported
Wong **et al, Arthroscopy 2013** [20]	HTO	Cultured Bone Marrow-Derived MSCs with Hyaluronic Acid	28	28	N.A	MSC (n = 28) v Control (HTO) (n = 28) 41.9 ± 19.2v 50.4 ± 23.0	MSC (n = 28) v Control (HTO) (n = 28) At latest follow-up (mean of 2 years) Added improvement of 7.61 (95% CI, 1.44 to 13.79; P = .016)for MSC group v Control	MSC (n = 28) v Control (HTO) (n = 28) 36.0 ± 13.7 v 33.9 ± 11.4	MSC (n = 28) v Control (HTO) (n = 28) At latest follow-up (mean of 2 years) Added improvement of 7.65 (95% CI, 3.04 to 12.26; P = .001) for MSC Group v Control	MSC (n = 28) v Control (HTO) (n = 28) 0–2: 15 v 16 3–5: 13 v 11 > 5: 0 v 1	MSC (n = 28) v Control (HTO) (n = 28) At latest follow-up (mean of 2 years) Added improvement of 0.64 (95% CI, 0.10 to 1.19; P = .021)for MSC Group v Control
Magnanelli *et al, Acta Biomedica 2020* [22]	HTO	Autologous Adipose-Derived MSCs	42	43	N.A	Not Reported	MSC (n = 42) v Control (HTO) (n = 43) At latest follow-up (mean of 1 year) No significant difference found between both groups (P > 0.05)	Not Reported	MSC (n = 42) v Control (HTO) (n = 43) At latest follow-up (mean of 1 year) No significant difference found between both groups (P > 0.05)	Not Reported	MSC (n = 42) v Control (HTO) (n = 43) At latest follow-up (mean of 1 year) No significant difference found between both groups (P > 0.05)

Study	Pre-OP Kanamiya Grading	Post-OP Kanamiya Grading	Pre-OP ICRS-CRA	Post-OP ICRS-CRA	Pre-OP VAS Score	Post-OP VAS Score	Pre-OP MOCART Score	Post-OP MOCART Score	Pre-OP KOOS Score	Post-OP KOOS Score
Kim **et al, American Journal of Sports Medicine 2018** [23]	Not Reported	Not reported	Not Reported	Control (n = 50) v MSC (n = 50) Femoral Condyle: Grade I: 2 v 4 Grade II: 6 v 13 Grade III: 26 v 20 Grade IV: 16 v 13 Tibial Plateau: Grade I: 3v 5 Grade II: 9 v 14 Grade III: 20 v 19 Grade IV: 18 v 12	Not reported	Not reported	Not reported	Not reported	Not reported	Not reported
Koh **et al, Arthroscopy 2014** [21]	Not Reported	PRP (Control) (n = 23) vs PRP with MSC (n = 21):	Not Reported	Not Reported	PRP (control) (n = 23) v PRP-MSC (n = 21) 45.4 ± 7.1 v 44.3 ± 5.7	PRP (control) (n = 23) v PRP-MSC (n = 21) At latest follow-up (mean 24.6 months (PRP) and 24.2 months (PRP-MSC)) 16.2 ± 4.6 v 10.2 ± 5.7	Not Reported	Not Reported	Not Reported	Not Reported
Wong **et al, Arthroscopy 2013** [20]	Not Reported	Not Reported	Not Reported	Not Reported	Not Reported	Not Reported	Not Reported	MSC (n = 28) v Control (HTO) (n = 28) At latest follow-up (mean of 2 years) 62.32 ± 17.56 v 43.21 ± 13.55	Not Reported	Not Reported
Magnanelli *et al, Acta Biomedica 2020* [22]	Not Reported	Not Reported	Not Reported	Not Reported	Not Reported	Not Reported	Not Reported	Not Reported	Not Reported	MSC (n = 42) v Control (HTO) (n = 43) At latest follow-up (mean of 1 year) No significant difference found between both groups (P > 0.05) in terms of ADL 1) Pain: no significant difference between both groups 2) Symptoms: no significant difference between both groups 3) ADL: p < 0.05 between both groups, with the MSC Group getting better results 4) Sports and rec: no significant difference between both groups 5) QOL: no significant difference between both groups

IKDC International Knee Documentation Committee, ICRS-CRA International Cartilage Repair Society – Cartilage Assessment, VAS Visual Analogue Scale, MOCART Magnetic Resonance Observation of Cartilage Repair Tissue, KOOS Knee injury and Osteoarthritis Outcome Score, HTO High Tibial Osteotomy, BMAC Bone Marrow Aspirate Concentrate, PRP Platelet-Rich Plasma, MSCs Mesenchymal Stem Cells, ADL Activities of Daily Living, QOL Quality of Life

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