관절경을 이용한 동종 제대혈 유래 간엽줄기세포 관절연골 재생 치료제(Cartistem®) 이식의 안정성 및 유효성

Abstract

Purpose: The purpose of this study is to report the safety and effectiveness of arthroscopic-assisted implantation of Cartistem®, an articular cartilage regeneration treatment composed of allogeneic umbilical cord blood-derived mesenchymal stem cell, while performing medial opening wedge high tibial osteotomy (owHTO) for Kellgren-Lawrence (KL) grades II and III patients with medial compartment osteoarthritis of the knee joint. The radiological and the clinical results are reported with a short-term follow-up of 1 year. Materials and Methods: From October 2017 to July 2019, arthroscopic chondroplasty using Cartistem® was performed along with medial owHTO on the lesion with ICRS grade IV among patients with medial compartment arthritis accompanied by varus knee. Out of 22 cases, 8 patients, who were followed up for more than 1 year and had 2nd look arthroscopy were studied retrospectively. The size of a chondral defect, K-L grade, and joint space distance (JSD) were measured from the radiographs before and 1 year after the surgery in the coronal and sagittal views of MRI by two investigators. As clinical scores, Knee Society Score (KSS) and Lysholm Score were measured before and 1 year after surgery. In all patients, the ICRS grade was measured at least 1 year after the operation date through plate removal and 2nd look arthroscopy. The Wilcoxon Test was used as the statistical method. Results: In radiological comparison before and after surgery, K-L grade has improved from K-L grade III to II in 2 patients (25.0%, P=0.50), and the joint space distance significantly improved from 3.75mm±1.24 to 4.63mm±1.21(P=0.01). The anatomical femorotibial angle was corrected from varus 2.46° to valgus 9.28°(P=0.01). In clinical score comparison, the KSS score increased from an average of 46.3 to an average of 70.50(P=0.01) and the Lysholm score increased from an average of 43.5 to an average of 75.5 (P=0.00), indicating a significant difference. It was confirmed that there was a significant improvement of ICRS grade in all patients through 2nd look arthroscopy. Conclusion: For patients with K-L grade II, III and ICRS Grade IV medial compartment osteoarthritis of the knee, chondroplasty using Cartistem® under arthroscopy during medial owHTO can significantly improve the radiological and clinical outcomes of the patient.