Study Of Intra-articular Of Autologous Adipose Mesenchymal Stem Cells Combined With High Tibial Osteotomy For Osteoarthritis

BackgroundOsteoarthritis is a chronic joint disease that affects the quality of life of patients.According to the cause of the disease,it is divided into primary and secondary osteoarthritis,which is mainly characterized by persistent destruction of articular cartilage,accompanied by changes of subchondral bone,synovium,meniscus,tendon ligament,and muscle.Osteoarthritis can affect all joints of the whole body,but it mainly affects the weight-bearing joints of the lower extremities leading to pain and dysfunction.In knee osteoarthritis,there are abnormalities in structure,biochemical composition,biomechanics,and cellular function of subchondral bone.The treatment of knee osteoarthritis includes exercise,weight loss,non-steroidal anti-inflammatory drugs,arthroscopic debridement,and joint replacement.But so far,none of these treatments can reverse knee joint degeneration and promote articular cartilage regenerationHigh tibial osteotomy(HTO)is a traditional knee-preserving operation.HTO retains the natural knee joint of patients with osteoarthritis,preserves the motor function and comfort of the joint to the greatest extent,and is more in line with the conservative,traditional cultural concept of "the ancestor of the body and skin,can not be reborn."Compared with joint replacement,HTO has inherent advantages.Mesenchymal stem cell(MSCs)has been paid more and more attention in repairing damaged cartilage.Adipose mesenchymal stem cell(adipose mesenchymal stem cells,ADMSCs)is a kind of mesenchymal stem cell.It has been found that injection of ADMSCs may alleviate or inhibit the progression of the disease by regulating the immune environment in the articular cavity,expressing related proteases,and forming new cartilage.At present there are few reports of ADMSCs combined with HTO in the treatment of knee osteoarthritis,and no consensus has been reached.[1]in this study,ADMSCs combined with HTO was used to treat knee osteoarthritis and to observe its effect on knee joint pain,motor function,and cartilage regeneration.Objectiveto evaluate the effectiveness of intra-articular of autologous adipose mesenchymal stem cells combined with high tibial osteotomy for osteoarthritis.MethodIn a randomized and parallel controlled study,28 patients with knee osteoarthritis from 2018.4 to 2019.10 were randomly divided into the experimental group(n=14)and the control group(n=14).The experimental group was treated with high tibial osteotomy and intra-articular injection of autologous adipose mesenchymal stem cells(HTO+ADMSCs group),and the control group was treated with high tibial osteotomy and standard saline injection(HTO group).Before the operation,blood routine,urine routine,liver and kidney function,electrocardiogram tumor marker series,knee joint MRI,lower limb standing full-length X-ray measured FTA angle,WOMAC,HSS,KSS,and VAS score.During the operation,the cartilage wear was evaluated by arthroscopy,and then the new lower limb force line measuring instrument was used to perform a high tibial osteotomy.In the HTO+ADMSCs group,50 ml of autologous abdominal subcutaneous fat was isolated and cultured at the same time of osteotomy,and the adipose mesenchymal stem cells were amplified and injected into the articular cavity on the 45th day after surgery.In the HTO group,standard saline 3ml was injected into the articular cavity on the 45th day after osteotomy.At 45 days,3 months,6 months,and 12 months after HTO,the standing full-length X-ray films of both lower limbs were taken to measure FTA,WOMAC,KSS,HSS,and VAS scores.Knee joint MRI was performed 12 months after HTO,and the condition of cartilage was evaluated by arthroscopic exploration at the same time of internal fixation taken.ResultAll patients were followed up for 12 to 20 months(mean 14±1.2 months).The force lines of lower extremities were effectively corrected through the X-ray examination 45 days after HTO.The FTA of HTO+ADMSCs group decreased from 183.00±4.70to 174.14±2.38,which was close to the average level,and the difference was statistically significant(p<0.05)The FTA of HTO group decreased from 187.93±5.92to 175.29±1.93,close to the average level,and the difference was statistically significant.The scores of WOMAC,KSS,HSS,and VAS in the two groups were significantly improved compared with those before the operation.There was a significant difference in the WOMAC score between the HTO+ADMSCs group and the HTO group at 45 days,3 months,6 months,and 12 months after operation(p<0.05).There was no significant difference in the scores of KSS and HSS at 45 days after HTO,but there was a considerable difference at 3 months,6months,and 12months after the operation(p<0.05).There was no significant difference in the VAS score at 45 days and 3 months after HTO,but there was a significant difference at 6 months and 12 months(p<0.05).At 12 months follow-up,complete cartilage regeneration was observed in 9 cases and partial cartilage regeneration in 4 cases in MRI of HTO+ADMSCs group,while complete cartilage regeneration was observed in 3 cases and partial cartilage regeneration in 7 cases in HTO group.Arthroscopic examination showed that complete cartilage regeneration was found in 9 cases,partial cartilage regeneration in 5 cases and no cartilage regeneration in 0 cases in HTO+ADMSCs group,while in HTO group,complete cartilage regeneration was found in 3 cases,partial cartilage regeneration in 9 cases and no cartilage regeneration in 2 cases.conclusionCompared with medial open wedge high tibial osteotomy alone,autologous adipose mesenchymal stem cells combined with high tibial osteotomy in the treatment of knee osteoarthritis can effectively reduce knee joint pain,improve motor function,and effectively improve the environment in the articular cavity and promote cartilage regeneration.