| Objective: Articular cartilage defect is very common in clinical practice,but so far there is no satisfactory solution that has been found in the world.Although many methods were used in clinical trials,the effect was not satisfactory.In recent years,bone morphogenetic proteins have attracted more and more attention in clinical research,but their efficacy for the repair of articular cartilage injury remains questionable,so most current researches on the repair of articular cartilage using bone morphogenetic proteins are confined to animal experiments.In this study,we will systematically evaluate relevant animal experimental studies to explore the effect of bone morphogenetic protein in repairing articular cartilage,which could obtain further best evidence for future clinical research..Methods: According to the retrieval strategy developed by the Chchrance Collaboration Network,the two researchers independently conducted electronic searches of PubMed?EMBASE,Wanfang database,CQVIP and CBMetc(from January 2000 to now)in English and Chinese language.Randomized controlled trials(RCTs)of bone morphogenetic protein in repairing articular cartilage injury were included.Base on the "Risk Assessment Tool" recommended by the Cochrance Collaboration,the risk assessment of bias was conducted to further extract the histology score data.For further study,the data with detailed scores(cell morphology,cell junctions,matrix staining and tide formation)were performed by subgroup analysis,and then divided into subgroups of 6 weeks and 12 weeks according to the time of the experiment.Finally,using RevMan 5.3 software,statistical analysis was conducted on the experimental group(vehicle + BMP)and the control group(blank group,vehicle group).The heterogeneity test was performed on the included studies,and X test was adopted to P<0.05 is the test level,and it is mainly based on I2 to judge the heterogeneity size.If statistical heterogeneity exists,the random effect model is used for analysis.Calculate the mean and standard deviation MD or SMD and 95% Confidence Interval(CI)for the continuous variables.When MD=1 or 95% confidence interval contains 1,the test effect is invalid,equivalent to P > 0.05,that is,no statistical significance.If the 95% confidence interval does not contain 1,it is equivalent to P < 0.05,which is statistically significant.Results: Seven randomized controlled trials(RCTs)involving 553 samples were included.Among the included studies,the methodological quality of the 4 studies is Grade A and that of 3 studies is Grade B.The meta-analysis results showed that the data in the experimental group compared with the blank group and the vehicle group respectively in 6 week(SMD = 7.19,95%CI: 2.16-12.22,P < 0.05;SMD = 3.46,95%CI:-0.02-6.95,P = 0.05 < 0.05,respectively)and 12 weeks(SMD = 10.94,95%CI: 0.20-21.68,P = 0.05;SMD = 3.17,95%CI: 0.73-5.61,P< 0.05,respectively),which indicated bone morphogenetie protein could promote the repair of articular cartilage ingury.Comparing the 6 week and 12 week experimental groups,the result(SMD =-1.97,95% CI:-3.7--0.23,P < 0.05)indicated that the longer the time,the more obvious the repair effect of BMP.A subgroup analysis showed that the experimental group was superior to the blank group and the vehicle group in cell morphology(SMD =-2.18,95%CI:-4.19--0.17),P < 0.05;SMD =-1.38,95%CI:-2,64--0.12,P < 0.05,respectively),cellular succession(SMD =-1.14,95%CI:-1.54--0.74,P < 0.05;SMD =-0.87,95%CI:-1.32--0.42,P < 0.05,respectively),matrix staining(SMD =-0.83,95%CI:-1.29--0.37,P < 0.05;SMD =-0.88,95%CI:-1.40--0.36),P < 0.05,respectively),and tide-scale formation(SMD =-2.18,95%CI(-4.37,0.02),P < 0.05;SMD =-0.95,95%CI:-1.86--0.04,P < 0.05,respectively).Indicated the new tissue repaired in the BMP group is closer to cartilage tissue.Conclusion:Bone morphogenetic protein has a certain effect in repairing articular cartilage injury.However,it still needs more high-quality RCTs to be verified owing to the limitations of the number and quality of included studies. |
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