Рossibilities of using stem cells for the treatment of osteochondritis fractures

Abstract

Transchondral fractures continue to be a challenging orthopedic condition due to impaired blood supply to the subchondral area, leading to detachment of the cartilage-bone fragment. This disease predominantly affects the knee and supracalcaneal joints, has a long course and seriously affects the quality of life of patients in many aspects, affects young, physically active people. The high rate of relapses after conventional surgical treatment prompts the investigation of regenerative treatments, among which cell therapy is a promising approach. The aim of the study is to review the data of studies in which stem cells are used to treat transchondral fractures. Materials and methods. A search of scientific sources indexed in the databases Scopus, PubMed and Google Scholar was conducted using the advanced search tool using the terms “stem cells” AND “osteochondral lesion” OR “osteochondritis dissecans” AND “cell therapy”. This study demonstrated that the use of MSCs stimulates the activation of bone and cartilage tissue regeneration, as they have the potential to differentiate into osteocytes and chondrocytes. MSC transplantation has a positive effect on fracture healing even in the case of nonunion or chronic inflammation, which allows avoiding invasive surgery in patients with concomitant disease. MSCs have angiogenic, immunomodulatory and antifibrotic effects, which can improve the quality of bone union. Systemic infusion of MSCs enhances mineralization and reduces fibrosis at the fracture site. In osteochondritis dissecans, successful repair of damaged articular surfaces has been described after autologous transplantation of MSCs derived from adipose tissue. Improved limb function (Lisholm score ≥20) has been found after cell therapy in young people. The authors of works in this field emphasize the pathogenetic significance of MSCs in specific injuries of the ankle joint, for which natural recovery is insufficient. The successful treatment of osteochondral lesions of the talus with synovial MSCs with functional recovery after 6 months has also been described. It has been recognized that the location of the cells (bone marrow, adipose tissue or synovium from which they were obtained) affects their osteogenic and chondrogenic potential, which should be taken into account when choosing a graft. Conclusions. Stem cell therapy is a new and well-known procedure for the treatment of transchondral fractures, which demonstrates remodeling of cartilage and bone with minimal invasive destruction. Multicenter studies are needed to standardize the approaches and ensure the availability of these technologies in routine clinical practice.