Using stromal stem cells to repair full-thickness meniscus defects

Complete localized damage to the meniscus can be the result of injuries and diseases. These lesions are located within the cartilage or involve the primary subchondral bone in the pathological process.

In the absence of timely treatment, the defect remains at the site of damage, or is filled with a connective tissue scar that cannot adequately transfer the loads exerted on the joint. As a result, an early atrophic degenerative lesion of the entire joint occurs. The patient suffers from pain, and the functionality of the joint is reduced. In the long term, progression of the disease may lead to the need for joint replacement surgery.

Mature hyaline cartilage is known to have a very low ability to regenerate. In this regard, a promising direction in the restoration of cartilage defects is the transplantation of cells capable of forming chondrogenesis, that is, forming cartilage. Mesenchymal stem cells are suitable for this purpose.

The method is based on a well-established idea of the ability of stem cells to transform into chondrocytes when exposed to certain environmental factors. Thus, if stem cells are isolated from the patient, then their number is increased and placed in an existing cartilage defect, and can be populated with regenerative tissue similar in morphological and functional characteristics to the surrounding meniscus.

The Republican Scientific and Practical Center for Traumatology and Orthopedics has developed and implemented a method for restoring full-layer cartilage damage in large joints using mesenchymal stem cell transplantation. MSCs are used from the patient’s bone marrow for transplantation. The most appropriate way to treat damaged cartilage in the knee joint.

Indications for the use of stem cells:

Traumatic lesions of the meniscus.
Degenerative and chronic lesions of the articular cartilage.
Anatomy of osteochondrosis.
It is recommended to replace defects with an area of more than 3 cm 2
Contraindications to the use of the method:
more than two cartilage defects or multiple defects (including “kissing”);
Systemic immune diseases with joint damage.
Arthritis
joint instability
Axial joint abnormalities more than 10.
In the preoperative period, the patient is subjected to the necessary examination, including an MRI of the joint to detect and determine the location of cartilage damage.

The treatment technique consists of 3 stages:

The first stage : endoscopic examination of the joint, correcting the associated diseases inside the joint, and determining the size of the defect to be filled. At the same time, a puncture is made in the pelvic bone and 40-100 ml of bone marrow is aspirated;
The second stage : the bone marrow is delivered to the cell laboratory. Mesenchymal stem cells are isolated from it, and their number increases to 10-40×106. Sterility and immune phenotype of cells are monitored. The in vitro culture phase lasts from 4 to 6 weeks;
third level
: Direct surgical implantation of a bio-cell product into a cartilage defect in a joint.

In the postoperative period, it may be recommended to walk with crutches without any load on the operated joint for 1-1.5 months.

Traumatic injury to the entire femoral condyle cartilage layer before treatment and 4 months after MSC implantation during arthroscopic examination of the joint. In the morphological study of regenerated chondrocytes and chondrocytes, the composition of the cartilage tissue is determined.