PMID- 33098949
OWN - NLM
STAT- MEDLINE
DCOM- 20210510
LR  - 20211213
IS  - 1526-3231 (Electronic)
IS  - 0749-8063 (Linking)
VI  - 37
IP  - 1
DP  - 2021 Jan
TI  - Intra-Articular Mesenchymal Stromal Cell Injections Are No Different From Placebo 
      in the Treatment of Knee Osteoarthritis: A Systematic Review and Meta-analysis of 
      Randomized Controlled Trials.
PG  - 340-358
LID - S0749-8063(20)30846-X [pii]
LID - 10.1016/j.arthro.2020.10.016 [doi]
AB  - PURPOSE: To evaluate the efficacy and safety of intra-articular mesenchymal 
      stromal cells (MSCs) injections for knee osteoarthritis (OA) treatment. METHODS: 
      We performed a systematic literature search in PubMed, Embase, Scopus, and the 
      Cochrane Library through April 2020 to identify level I randomized controlled 
      trials (RCTs) that evaluated the clinical efficacy of MSCs versus control 
      treatments for knee OA. Outcomes were analyzed on an intention-to-treat basis 
      with random-effects models. RESULTS: A total of 13 RCTs were included in the 
      meta-analysis. Compared with placebo, there was no significant difference in VAS 
      for pain (mean difference [MD] 1.62, 95% confidence interval [CI -0.60 to 3.85), 
      WOMAC pain score (MD 1.88, 95% CI -0.21 to 3.98), WOMAC function score (MD -0.67, 
      95% CI -6.54 to 5.19), or WOMAC stiffness score (MD 0.64, 95% CI -0.86 to 2.14) 
      for MSCs. Moreover, the smallest treatment effect of VAS for pain, WOMAC pain 
      score, WOMAC function score, and WOMAC stiffness score did not exceed the minimum 
      clinically important difference (MCID). Additionally, there was no significant 
      difference in percentage of patients crossing the MCID threshold between MSC and 
      placebo groups for VAS for pain (relative risk [RR] 0.93, 95% CI 0.55 to 1.57) or 
      WOMAC total score (RR 0.40, 95% CI 0.13 to 1.21). Compared with hyaluronic acid 
      (HA), MSC injection was associated with significantly better improvement in VAS 
      for pain (MD 2.00, 95% CI 0.94 to 3.07), WOMAC pain score (MD 4.58, 95% CI 0.49 
      to 8.67), WOMAC total score (MD 14.86, 95% CI 10.59 to 19.13), and WOMAC 
      stiffness score (MD 1.85, 95% CI 0.02 to 3.69). However, the smallest treatment 
      effect of VAS for pain, WOMAC pain score, WOMAC function score, and WOMAC 
      stiffness score did not exceed the MCID. Moreover, there was no significant 
      difference in percentage of patients crossing the MCID threshold between MSC and 
      HA groups for WOMAC total score (RR 0.57, 95% CI 0.21 to 1.55). We also found 
      that MSCs did not increase adverse events compared with HA and placebo. 
      CONCLUSIONS: Intra-articular MSC injection was not found to be superior to 
      placebo in pain relief and functional improvement for patients with symptomatic 
      knee OA. However, additional direct testing and combination trials of different 
      type of cells, doses, and number of injections of MSCs are required to further 
      enhance clinical decision making for people with symptomatic knee OA. LEVEL OF 
      EVIDENCE: I, meta-analysis of level I studies.
CI  - Copyright (c) 2020 Arthroscopy Association of North America. Published by Elsevier 
      Inc. All rights reserved.
FAU - Dai, Wenli
AU  - Dai W
AD  - Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking 
      University Third Hospital, Beijing, People's Republic of China.
FAU - Leng, Xi
AU  - Leng X
AD  - Medical Imaging Center, The First Affiliated Hospital of Guangzhou University of 
      Chinese Medicine, Guangdong, People's Republic of China.
FAU - Wang, Jian
AU  - Wang J
AD  - Department of Orthopedic Surgery, Nanfang Hospital, Southern Medical University, 
      Guangdong, People's Republic of China.
FAU - Shi, Zhanjun
AU  - Shi Z
AD  - Department of Orthopedic Surgery, Nanfang Hospital, Southern Medical University, 
      Guangdong, People's Republic of China.
FAU - Cheng, Jin
AU  - Cheng J
AD  - Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking 
      University Third Hospital, Beijing, People's Republic of China.
FAU - Hu, Xiaoqing
AU  - Hu X
AD  - Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking 
      University Third Hospital, Beijing, People's Republic of China. Electronic 
      address: xiaoqinghubj@163.com.
FAU - Ao, Yingfang
AU  - Ao Y
AD  - Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking 
      University Third Hospital, Beijing, People's Republic of China. Electronic 
      address: aoyingfang@126.com.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20201021
PL  - United States
TA  - Arthroscopy
JT  - Arthroscopy : the journal of arthroscopic & related surgery : official 
      publication of the Arthroscopy Association of North America and the International 
      Arthroscopy Association
JID - 8506498
SB  - IM
CIN - Arthroscopy. 2021 Jan;37(1):359-361. PMID: 33384092
CIN - Arthroscopy. 2021 May;37(5):1361-1362. PMID: 33896482
CIN - Arthroscopy. 2021 May;37(5):1362-1364. PMID: 33896483
CIN - Arthroscopy. 2021 Dec;37(12):3390-3391. PMID: 34863375
CIN - Arthroscopy. 2021 Dec;37(12):3391-3392. PMID: 34863376
MH  - Humans
MH  - Injections, Intra-Articular
MH  - Knee Joint
MH  - Mesenchymal Stem Cell Transplantation/*methods
MH  - Mesenchymal Stem Cells/*cytology
MH  - Minimal Clinically Important Difference
MH  - Osteoarthritis, Knee/*therapy
MH  - *Randomized Controlled Trials as Topic
MH  - Treatment Outcome
EDAT- 2020/10/26 06:00
MHDA- 2021/05/11 06:00
CRDT- 2020/10/25 00:01
PHST- 2020/06/26 00:00 [received]
PHST- 2020/10/08 00:00 [revised]
PHST- 2020/10/08 00:00 [accepted]
PHST- 2020/10/26 06:00 [pubmed]
PHST- 2021/05/11 06:00 [medline]
PHST- 2020/10/25 00:01 [entrez]
AID - S0749-8063(20)30846-X [pii]
AID - 10.1016/j.arthro.2020.10.016 [doi]
PST - ppublish
SO  - Arthroscopy. 2021 Jan;37(1):340-358. doi: 10.1016/j.arthro.2020.10.016. Epub 2020 
      Oct 21.