The field of tissue engineering is currently in its infancy. Over the past decades the challenge of treating defects in joint cartilage has frustrated orthopedic surgeons and scientists who perform research to develop new treatments for osteoarthritis. Moreover, it is assumed that joint cartilage defects lead to the development of accelerated osteoarthritis and therefore use of tissue-based therapies for managing these defects is very much needed.
One of the key features of joint cartilage is that it is avascular. In other words, it does not have an adequate blood supply and therefore cannot recruit cells to help repair injuries when they occur.
Approximately 15 years ago a treatment known as autologous chondrocyte implantation (ACI ) was developed. This involves harvesting cells from the patient’s own joint cartilage, growing the cells outside the body and then implanting them into areas of cartilage damage in order to produce healing. However, there are limitations to this procedure. These limitations include subjecting the patient to a second operation and preventing the development of tumors because the cells were manipulated outside the body. To address this, a study was conducted to test if bone marrow stem cells can produce the same effect as ACI.
Seventy-two patients underwent treatment with either ACI or bone marrow-derived stem cells and matched with regard to age and lesion site. They were followed for a median of at least 10 years and were assessed with a Short Form Health Survey instrument. The results showed that there was an improvement in all patients but there was no significant difference in treatment with ACI or bone marrow-derived stem cells. Stem cell implantation used for the treatment of chondral defects produced equivalent clinical outcomes to ACI after 10 years with no apparent increase in tumor risk.
This study shows that good results can be obtained in a group of older patients with the use of bone marrow stem cells. These cells are as effective or more so than ACI, are relatively easy to isolate, and have the advantage of avoiding a second surgical procedure.
Teo et al.: Equivalent 10-Year Outcomes After Implantation of Autologous Bone Marrow-Derived Mesenchymal Stem Cells Versus Autologous Chondrocyte Implantation for Chondral Defects of the Knee. AM J SPORTS MED 47:2881, 2019.