A New Advanced Osteoarthritis Treatment Utilizing Modified Mesenchymal Stem Cells: Arthroscopic Guided Intra-Articular Intervention Approach a Systematic Review and Meta-Analysis

Abstract

Background Mesenchymal stem cells (MSCs) can help repair damaged cartilage in osteoarthritis (OA) and prevent disability. Combining MSCs with platelet-rich plasma (PRP) and hyaluronic acid (HA) might make this treatment more effective. This study aims to find out how well MSCs, PRP, and different HA doses work together, what's the best source of MSCs, and how many MSCs to use for treating osteoarthritis and regenerating cartilage. Method The sources included were original articles published from 2013 until 2023 from 4 databases. Studies included were original research of clinical trials or randomized controlled trials. Irrelevant studies were excluded. Then, the ROB-2 taken was used to assess bias. The result was constructed with PICOS criteria table. MRI score, VAS score, Lysholm score, Cartilage volume, size of cartilage defect, Knee Society Clinical Rating System Score (KSS), and WOMAC index to evaluate treatment’s effication outcomes were analyzed by Revman 5.4. This systematic review followed the PRISMA guidelines. Result nine studies were included in the final screening. The meta-analysis showed a significant (P < 0.00001) elevation of Lysholm score with a pooled mean difference (MD) of (17.89) (95% CI: 16.01, 19.77; I2 = 0%, P = 0.56); a significant reduction (P < 0.00001) of VAS score with a pooled MD of (-2.62) (95% CI: -2.83, -2.41; I2 = 99%, P <0.00001); Knee society clinical rating system score (KSS) evaluation also showed significant elevation (P< 0.00001) with mean polled (29.59) (95% CI: 27.66, 31.52; I2= 95%, P< 0.0001); and significantly reduction (P< 0.00001) of WOMAC score occurred as pooled MD of (-12.38) (95% CI: -13.75, -11.01; I2= 99%, P< 0.0001). Conclusions Arthroscopic guided high-dose subchondral application of primary cultured synovial mesenchymal stem cells in popliteal platelet-rich plasma media combined with hyaluronic acid effectively regenerate cartilage defect and increase clinical outcomes in the early stage of osteoarthritis.