Cartilage Repair in the Knee Using Umbilical Cord Wharton’s Jelly Derived Mesenchymal Stem Cells Embedded Onto Collagen Scaffolding and Implanted Under Dry Arthroscopy
Arthroscopy Techniques, Vol 7, No 1 (January), 2018: pp e57-e63 https://doi.org/10.1016/j.eats.2017.08.055
Boguslaw Sadlik, M.D., Ph.D., Grzegorz Jaroslawski, M.D., Mariusz Puszkarz, M.D., Adrian Blasiak, M.D., Ph.D., Tomasz Oldak, Ph.D., Dominika Gladysz, M.D., and Graeme P. Whyte, M.D., M.Sc.
Cell-based cartilage repair procedures are becoming more widely available and have shown promising po- tential to treat a wide range of cartilage lesion types and sizes, particularly in the knee joint. More recently, techniques have evolved from 2-step techniques that use autologous chondrocyte expansion to 1-step techniques that make use of mesenchymal stem cells (MSCs) embedded onto biocompatible scaffolding. Our 1-step technique has been further developed to provide cell-based cartilage repair using MSCs that have the potential to be used in an off-the-shelf manner, without the need for autologous tissue harvest. Precursor MSCs can be isolated in abundance from the Wharton’s jelly of umbilical cord tissue. These cells have been shown to have the desired capacity for proliferation, differentiation, and release of trophic factors that make them an excellent candidate for use in the clinical setting to provide cell-based restoration of hyaline-like cartilage. Although allogeneic in nature, these cells stimulate little or no host immune response and can be stored for long periods while maintaining viability. We present a technique of cartilage repair in the knee using Wharton’s jellyederived MSCs embedded onto scaffolding and implanted in a minimally invasive fashion using dry arthroscopy.
Ideal cartilage repair procedures should provide restoration of hyaline-like articular cartilage and be performed in a minimally invasive, single-stage manner to minimize patient morbidity. The use of MSCs sourced from autologous tissue in combination with biocompatible scaffolding has shown encouraging clinical results at medium term, comparable with more traditional methods of cell-based cartilage repair using autologous chondrocytes. The use of WJ- MSCeembedded scaffolds for cartilage repair proced- ures provides the additional potential advantages of off-the-shelf use and avoidance of morbidity related to autologous tissue harvest. It is important to note that this technique may be used in older patients to provide a source of stem cells for cartilage repair that do not have limited regenerative and trophic properties. Although initial results are encouraging, further clinical follow-up will be necessary to compare the success of this procedure with other methods of cell-based carti- lage repair.