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.
