Knee Surg Relat Res  
Intra-Articular Injection of Bone Marrow-Derived Mesenchymal Stem Cells Leading to Better Clinical Outcomes without Difference in MRI Outcomes from Baseline in Patients with Knee Osteoarthritis
Young-Soo Shin, MD, PhD1,*, Jung-Ro Yoon, MD, PhD1,*, Hee-Sun Kim, RN, PhD2, and Seon-Heui Lee, RN, PhD3
1Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul; 2Chonbuk Research Institute of Nursing Science, College of Nursing, Chonbuk National University, Jeonju; 3Department of Nursing Science, College of Nursing, Gachon University, Incheon, Korea
Correspondence to: Seon-Heui Lee, RN, PhD
Department of Nursing Science, College of Nursing, Gachon University, 21 Namdong-daero, 774 beon-gil, Namdong-gu, Incheon 21565, Korea
Tel: +82-32-820-4230, Fax: +82-32-820-4231
E-mail: sunarea87@gachon.ac.kr
*These authors contributed equally to this study.
Received: December 19, 2017; Revised: February 6, 2018; Accepted: April 24, 2018; Published online: July 6, 2018.
© Korean Knee Society. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Purpose: Bone marrow (BM) is frequently used as a source of mesenchymal stem cells (MSCs) because they have a high potential for differentiation. However, it is unclear whether BM-derived MSCs lead to better clinical and magnetic resonance imaging (MRI) outcomes postoperatively.
Materials and Methods: This meta-analysis compared the clinical and MRI outcomes in patients with knee osteoarthritis (OA) treated with BM-derived MSCs. Eight studies comparing the clinical and MRI outcomes assessed with various measurement tools in patients with knee OA treated with BM-derived MSCs were included.
Results: The range of motion (95% confidence interval [CI], –13.05 to 4.24; p=0.32) and MRI outcomes (95% CI, –0.16 to 1.40; p=0.12) did not differ significantly between the baseline and final follow-up. In contrast, pain (95% CI, 0.89 to 1.87; p<0.001) and functional outcomes (95% CI, 0.70 to 2.07; p<0.001) were significantly improved at the final follow-up when compared to the baseline.
Conclusions: This meta-analysis found no significant difference in the tested range of motion and MRI outcomes between the baseline and the final follow-up in patients treated with BM-derived MSCs, whereas significant functional improvement and pain relief were noted when compared with the baseline. Thus, BM-derived MSCs appear to be a viable alternative for patients with knee OA, although long-term and high-quality randomized controlled trials are needed to confirm the clinical benefits.
Keywords: Knee, Osteoarthritis, Bone marrow, Mesenchymal stem cells, Meta-analysis


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