title: Comparative outcomes of open-wedge high tibial osteotomy with platelet-rich plasma alone or in combination with mesenchymal stem cell treatment: a prospective study.
abstract: OBJECTIVE
  This study compared the clinical results and second-look arthroscopic findings of patients undergoing open-wedge high tibial osteotomy (HTO) for varus deformity, with or without mesenchymal stem cell (MSC) therapy.
  
  
  METHODS
  This prospective, comparative observational study was designed to evaluate the effectiveness of MSC therapy. The patients were divided into 2 groups: HTO with platelet-rich plasma (PRP) injection only (n = 23) or HTO in conjunction with MSC therapy and PRP injection (n = 21). Prospective evaluations of both groups were performed using the Lysholm score, Knee Injury and Osteoarthritis Outcome Score (KOOS), and a visual analog scale (VAS) score for pain. Second-look arthroscopy was carried out in all patients at the time of metal removal.
  
  
  RESULTS
  The patients in the MSC-PRP group showed significantly greater improvements in the KOOS subscales for pain (PRP only, 74.0 ± 5.7; MSC-PRP, 81.2 ± 6.9; P < .001) and symptoms (PRP only, 75.4 ± 8.5; MSC-PRP, 82.8 ± 7.2; P = .006) relative to the PRP-only group. Although the mean Lysholm score was similarly improved in both groups (PRP only, 80.6 ± 13.5; MSC-PRP, 84.7 ± 16.2; P = .357), the MSC-PRP group showed a significantly greater improvement in the VAS pain score (PRP only, 16.2 ± 4.6; MSC-PRP, 10.2 ± 5.7; P < .001). There were no differences in the preoperative (PRP only, varus 2.8° ± 1.7°; MSC-PRP, varus 3.4° ± 3.0°; P = .719) and postoperative (PRP only, valgus 9.8° ± 2.4°; MSC-PRP, valgus 8.7° ± 2.3°; P = .678) femorotibial angles or weight-bearing lines between the groups. Arthroscopic evaluation, at plate removal, showed that partial or even fibrocartilage coverage was achieved in 50% of the MSC-PRP group patients but in only 10% of the patients in the PRP-only group (P < .001).
  
  
  CONCLUSIONS
  MSC therapy, in conjunction with HTO, mildly improved cartilage healing and showed good clinical results in some KOOS subscores and the VAS pain score compared with PRP only.
  
  
  METHODS
  Level II, prospective comparative study.
authors.affiliation: Center for Stem Cell & Arthritis Research, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, South Korea.
authors.forename: Yong-Gon
authors.initials: YG
authors.lastname: Koh
authors.affiliation: Center for Stem Cell & Arthritis Research, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, South Korea.
authors.forename: Oh-Ryong
authors.initials: OR
authors.lastname: Kwon
authors.affiliation: Center for Stem Cell & Arthritis Research, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, South Korea.
authors.forename: Yong-Sang
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Center for Stem Cell & Arthritis Research, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, South Korea. Electronic address: yunjinchoi78@gmail.com.
authors.forename: Yun-Jin
authors.initials: YJ
authors.lastname: Choi
mesh_terms: D001182:Arthroscopy; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000601:surgery; D008297:Male; D045164:Mesenchymal Stem Cell Transplantation; D059630:Mesenchymal Stem Cells; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery / Q000628:therapy*; D010027:Osteotomy / Q000379:methods*; D010147:Pain Measurement; D053657:Platelet-Rich Plasma; D011446:Prospective Studies; D024162:Second-Look Surgery / Q000379:methods; D013977:Tibia / Q000002:abnormalities* / Q000601:surgery; D016896:Treatment Outcome; D016474:Weight-Bearing