Comparison of Bone Marrow Aspirate Concentrate and Allogeneic Human Umbilical Cord Blood-derived Mesenchymal Stem Cells in Patients with Kissing Lesion on Initial Arthrocopy After High Tibial Osteotomy in Medial Unicompartmental Osteoarthritis of Knee

Purpose: The purpose of this study was to compare the outcome of cartilage regeneration between bone marrow aspirate concentrate (BMAC) augmentation and the stem cell-based medicinal product (a composite of culture-expanded allogeneic hUCB-MSCs and hyaluronic acid hydrogel [Cartistem]) in medial unicompartmental osteoarthritis of knee Methods: Out of 81 cases underwent for second look arthroscopy who treated for medial unicompartmental osteoarthritis between 2016 and 2019, 31 cases were kissing lesion which was shown full thickness cartilage defect(over ICRS grade 3B) in medial femoral cartilage and medial tibial cartilage at initial surgery. We retrospectively compared clinical outcomes, including International Knee Documentation Committee (IKDC) subjective score, Knee Society Score (KSS) pain and function, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score between BMAC group comprising of 25 cases and Cartistem group comprising of 14 cases at minimum of 1 year follow up. Also, cartilage regeneration was graded by International Cartilage Repair Society Cartilage Repair Assessment (ICRS CRA) grading system at secondary arthroscopy. Radiologic measurement including Hip-Knee-Ankle (HKA) angle, posterior tibial slope angle, and correction angle were assessed. Results: At the final follow-up, clinical outcomes were improved. However, there were no statistical significances between two groups in clinical outcome and radiologic outcome(p>0.05). Regarding the findings of second-look arthroscopy, Cartistem group was significantly better than BMAC group in medial femoral cartilage and medial tibial cartilage(p=0.002, 0.000). About medial femoral cartilage, grade I cartilage regeneration was found in 0 case, grade II in 10 cases (40%), grade III in 6 cases (16%), grade IV in 9 cases (36%) in BMAC group and grade I cartilage regeneration was found in 1 case (7.1%), grade II in 11 cases (85.7%), and grade III in 1 case (7.1%) in Cartistem group. About medial tibial cartilage, grade I cartilage regeneration was found in 0 case , grade II in 8 cases (32%), grade III in 4 cases (16%), grade IV in 13 cases (52%) in BMAC group and grade I cartilage regeneration was found in 0 case, grade II in 12 cases (85.7%), and grade III in 1 case(7.1%), grade IV in 1 case (7.1%) in cartistem group. Conclusion: Clinical outcomes were improved regardless of which augmentation was administered. However, microfracture with Cartistem is more effective for cartilage regeneration than microfracture with BMAC in medial unicompartmental OA. Keywords : High tibial osteotomy, Unicompartmental osteoarthritis, Microfracture, Cartilage regeneration, Bone marrow aspirate concentrate, Cartistem.

UNICOMPARTMENTAL OSTEOARTHRITIS OF KNEE

Background: Osteoarthritis is more common in females because inpostmenopausal state, it is linked with high body weight, higher subcutaneous fat, deficiencyof calcium and weakness of muscles associated with changes in harmones. Objectives: Toassess the outcome of high tibial osteotomy in unicompartmental osteoarthritis of knee in termsof pain and improvement in function. Study Design: Prospective study. Setting: King AbdullahTeaching Hospital, Mansehra. Period: 1st January 2016 to 31st December 2017. Materialsand Methods: Two hundred and forty eight cases were included in which twenty cases wereoperated by the use of modified coventry technique, twenty cases were operated by openwedge osteotomy with non locking plates as well as bone graft and remaining 208 cases wereoperated by medial open wedge osteotomy and iliac graft secured by locking plate. In all casesat eight weeks, six weeks and third post operative day respectively allowed full weight bearing.Post-operative changes in tibio femoral angle included in radiographical analysis. 2 years meanfollow-up of all these cases. Results: Function score and pain of knee improved considerably asthe p value <0.001 in our study. Maximum pain score is 50, pre-operatively average pain scorewas 18±7 and 44±5 was postoperatively. There was a significant improvement at two years inthe function of cases 244 (98.38%) according to grading used for judgment of function in kneescore. Pre-operatively mean functional knee score in 110 cases (88.70%) cases were 28.86,(100 is the maximum functional knee score) and 70.45 was post-operatively. In tibiofemoralangle there was a correction of 5.2±1.5 degree varus preoperatively and postoperatively aswell as valgus 5.8±1.3 degree respectively. Conclusion: In function and pain of the knee,there was significant improvement after the deformity correction (p value <0.001). In 88.23%outcomes of high tibial osteotomy in knees rated as excellent. Due to associated comorbidityand excessive over correction, there were poor outcomes in two cases. There is significantassociation between the obtained postoperative valgus and relief in pain.