title: The Clinical Use of Human Culture-Expanded Autologous Bone Marrow Mesenchymal Stem Cells Transplanted on Platelet-Rich Fibrin Glue in the Treatment of Articular Cartilage Defects: A Pilot Study and Preliminary Results.
abstract: OBJECTIVE: To test the hypothesis that platelet-rich fibrin glue (PR-FG) can be used clinically as a scaffold to deliver autologous culture-expanded bone marrow mesenchymal stem cells (BM-MSCs) for cartilage repair and to report clinical results 1 y after implantation of MSCs PR-FG. PATIENTS AND METHODS: Autologous BM-MSCs were culture expanded, placed on PR-FG intraoperatively, and then transplanted into 5 full-thickness cartilage defects of femoral condyles of 5 patients and covered with an autologous periosteal flap. Patients were evaluated clinically at 6 and 12 mo by the Lysholm and Revised Hospital for Special Surgery Knee (RHSSK) scores and radiographically by x-rays and magnetic resonance imaging (MRI) at the same time points. Repair tissue in 2 patients was rated arthroscopically after 12 mo using the International Cartilage Repair Society (ICRS) Arthroscopic Score. STUDY DESIGN: Case series; level of evidence 4. RESULTS: All patients' symptoms improved over the follow-up period of 12 mo. Average Lysholm and RHSSK scores for all patients showed statistically significant improvement at 6 and 12 mo postoperatively (P < 0.05). There was no statistically significant difference between the 6 and 12 mo postoperative clinical scores (P = 0.18). ICRS arthroscopic scores were 8/12 and 11/12 (nearly normal) for the 2 patients who consented to arthroscopy. MRI of 3 patients at 12 mo postoperatively revealed complete defect fill and complete surface congruity with native cartilage, whereas that of 2 patients showed incomplete congruity. CONCLUSION: Autologous BM-MSC transplantation on PR-FG as a cell scaffold may be an effective approach to promote the repair of articular cartilage defects of the knee in human patients.
authors.affiliation: Department of Orthopedic Surgery, Cairo University School of Medicine, Cairo, Egypt.
authors.forename: Amgad M
authors.initials: AM
authors.lastname: Haleem
authors.forename: Abdel Aziz El
authors.initials: AA
authors.lastname: Singergy
authors.forename: Dina
authors.initials: D
authors.lastname: Sabry
authors.forename: Hazem M
authors.initials: HM
authors.lastname: Atta
authors.forename: Laila A
authors.initials: LA
authors.lastname: Rashed
authors.forename: Constance R
authors.initials: CR
authors.lastname: Chu
authors.forename: Mohammed T
authors.initials: MT
authors.lastname: El Shewy
authors.forename: Akram
authors.initials: A
authors.lastname: Azzam
authors.forename: Mohammed T
authors.initials: MT
authors.lastname: Abdel Aziz