Allogeneic Umbilical Cord-Blood-Derived Mesenchymal Stem Cells and Hyaluronate Composite Combined with High Tibial Osteotomy for Medial Knee Osteoarthritis with Full-Thickness Cartilage Defects

Background and Objectives: Although the effects of cartilage repair in patients who are undergoing high tibial osteotomy (HTO) remains controversial, cartilage repair may be required for the full-thickness cartilage defect because of a concern of lower clinical outcome. The purpose of this study was to investigate clinical outcome and cartilage repair following implantation of allogeneic umbilical cord-blood-derived MSCs (UCB-MSCs)-hyaluronate composite in patients who received HTO for medial knee osteoarthritis (OA) with full-thickness cartilage defect. Materials and Methods: Inclusion criteria were patients with a medial knee OA, a full-thickness cartilage defect (International Cartilage Repair Society (ICRS) grade IV) >= 3 cm(2) of the medial femoral condyle, and a varus deformity >= 5 degrees. The full-thickness cartilage defect was treated with implantation of an allogeneic UCB-MSCs-hyaluronate composite following medial open-wedge HTO. Visual analogue scale for pain and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score were assessed at each follow-up. Cartilage repair was assessed by the ICRS cartilage repair assessment system at second-look arthroscopy when the plate was removed. Results: Twelve patients (mean age 56.1 years; mean defect size: 4.5 cm(2)) were included, and 10 patients underwent second-look arthroscopy during plate removal after a minimum of 1 year after the HTO. At the final follow-up of mean 2.9 years (range; 1-6 years), all clinical outcomes had improved. At second-look arthroscopy, repaired tissue was observed in all cases. One case (10%) showed grade I, seven (70%) cases showed grade II, and two (20%) cases showed grade III according to ICRS cartilage repair assessment system, which meant that 80% showed an overall repair assessment of "normal" or "nearly normal". Conclusion: Allogeneic UCB-MSCs-HA composite implantation combined with HTO resulted in favorable clinical outcome and cartilage repair in all cases. These findings suggest that UCB-MSCs-HA composite implantation combined with HTO would be a good therapeutic option for patients with knee OA and full-thickness cartilage defects.