title: Does an injection of a stromal vascular fraction containing adipose-derived mesenchymal stem cells influence the outcomes of marrow stimulation in osteochondral lesions of the talus? A clinical and magnetic resonance imaging study.
abstract: BACKGROUND
  Marrow stimulation for the treatment of osteochondral lesions of the talus (OLTs) is controversial in patients with poor prognostic factors of OLTs. Currently, mesenchymal stem cells (MSCs) are expected to biologically augment the treatment of OLTs.
  
  
  OBJECTIVE
  To compare the clinical and magnetic resonance imaging (MRI) outcomes between an injection of MSCs with marrow stimulation and marrow stimulation alone in patients with OLTs.
  
  
  METHODS
  Cohort study; Level of evidence, 3.
  
  
  METHODS
  A total of 49 patients (50 ankles) with OLTs underwent follow-up MRI after arthroscopic treatment. Among these 50 ankles, 26 underwent marrow stimulation alone (conventional group), and 24 underwent marrow stimulation with an injection of a stromal vascular fraction (SVF) containing MSCs (MSC group). Clinical outcomes were evaluated according to the visual analog scale (VAS) for pain, American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale, and Tegner activity scale. The magnetic resonance observation of cartilage repair tissue (MOCART) score was used for the MRI evaluation of repaired lesions.
  
  
  RESULTS
  The mean VAS score, AOFAS score, and Tegner score improved from 7.1 ± 1.2, 68.5 ± 5.6, and 3.4 ± 0.6 to 3.9 ± 0.8, 78.3 ± 4.9, and 3.5 ± 0.8, respectively, in the conventional group and from 7.1 ± 0.8, 67.7 ± 4.7, and 3.4 ± 0.5 to 3.2 ± 0.8, 83.3 ± 7.0, and 3.9 ± 0.7, respectively, in the MSC group. All clinical outcomes, including the VAS, AOFAS, and Tegner scores, improved significantly in the MSC group compared with the conventional group (P = .003, .009, and .041, respectively). There was a significant difference (P = .037) in the mean MOCART score between the conventional and MSC groups (49.4 ± 16.6 vs 62.1 ± 21.8, respectively), and significant correlations of the MOCART score with clinical outcomes were found in both groups (P < .05). Patient age (≥46.1 years), large lesion size (≥151.2 mm(2)), and the presence of subchondral cysts were associated with a worse MOCART score in the conventional group (P = .015, .004, and .013, respectively) but not in the MSC group.
  
  
  CONCLUSIONS
  Clinical and MRI outcomes of an injection of an SVF containing MSCs with marrow stimulation were encouraging, compared with marrow stimulation alone, for the treatment of OLTs. Therefore, an injection of an SVF containing MSCs with marrow stimulation should be considered as a treatment for OLTs, even when poor prognostic factors, including older age, large-sized lesion, or the presence of subchondral cysts, exist.
authors.affiliation: Center for Stem Cell and Arthritis Research, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Korea.
authors.forename: Yong Sang
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Center for Stem Cell and Arthritis Research, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Korea.
authors.forename: Ho Jin
authors.initials: HJ
authors.lastname: Lee
authors.affiliation: Center for Stem Cell and Arthritis Research, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Korea.
authors.forename: Yun Jin
authors.initials: YJ
authors.lastname: Choi
authors.affiliation: Center for Stem Cell and Arthritis Research, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Korea.
authors.forename: Yong Il
authors.initials: YI
authors.lastname: Kim
authors.affiliation: Center for Stem Cell and Arthritis Research, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Korea yonggonkoh@gmail.com.
authors.forename: Yong Gon
authors.initials: YG
authors.lastname: Koh
mesh_terms: D000273:Adipose Tissue / Q000166:cytology; D000328:Adult; D000367:Age Factors; D054544:Arthroplasty, Subchondral; D001845:Bone Cysts / Q000150:complications; D001853:Bone Marrow / Q000502:physiology; D002356:Cartilage / Q000293:injuries* / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D008279:Magnetic Resonance Imaging; D008297:Male; D045164:Mesenchymal Stem Cell Transplantation; D008875:Middle Aged; D012189:Retrospective Studies; D013628:Talus / Q000293:injuries*; D064232:Visual Analog Scale; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult
keywords: MRI; marrow stimulation; mesenchymal stem cell; osteochondral lesion of the talus