Stem cells Chondral Defects of the 1st Metatarsophalangeal Joint

NewsBot · May 28, 2016

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Matrix-Associated Stem Cell Transplantation (MAST) in Chondral Defects of the 1st Metatarsophalangeal Joint is Safe and Effective - 2-Year-Follow-up in 20 Patients
Martinus Richter, , Stefan Zech, Stefan Meissner
Foot and Ankle Surgery; 27 May 2016

Highlights
?Twenty patients with 25 defects were included in the study.
?All patients completed 2-year-followup.
?VAS FA improved to 91.5 (range, 74.2-100; t-test, p<.01).
?ROM improved to 34.5/0/25.5 (p=.05).
?The surgical treatment including MAST led to improved clinical scores and ROM.
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The aim of the study was to assess the 2-year-follow-up of matrix-associated stem cell transplantation (MAST) in chondral defects of the 1st metatarsophalangeal joint (MTPJ).

In a prospective consecutive non-controlled clinical follow-up study, 20 patients with 25 chondral defect at the 1st MTPJ that were treated with MAST from October 1st, 2011 to March, 30th, 2013 were analysed. The size and location of the chondral defects range of motion (ROM), and the Visual-Analogue-Scale Foot and Ankle (VAS FA) before treatment and at follow-up were registered.

Stem cell-rich blood was harvested from the ipsilateral pelvic bone marrow and centrifuged (10 minutes, 1,500 RPM). The supernatant was used to impregnate a collagen I/III matrix (Chondro-Guide). The matrix was fixed into the chondral defect with fibrin glue.

The age of the patients was 42 years on average (range, 35-62 years). The VAS FA before surgery was 50.5 (range, 18.3-78.4). The defects were located as follows, dorsal metatarsal head, n = 12, plantar metatarsal head, n = 5, dorsal & plantar, n = 8 (two defects, n = 5). The defect size was 0.7 cm2 (range, .5 - 2.5 cm2). ROM was 10.3/0/18.8? (dorsal extension/plantar flexion). All patients completed 2-year-follow-up. VAS FA improved to 91.5 (range, 74.2-100; t-test, p<.01). ROM improved to 34.5/0/25.5 (p=.05).

The surgical treatment including MAST led to improved clinical scores and ROM. Even though a control group is missing, we conclude that MAST is a safe and effective method for the treatment of chondral defects of the 1st MTPJ.
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NewsBot · Nov 8, 2017

Intra-articular Mesenchymal Stem Cell Therapy for the Human Joint: A Systematic Review
James A. McIntyre, BS, Ian A. Jones, BA, Bo Han, PhD, ...
The American Journal of Sports Medicine November 3, 2017

Background:
Stem cell therapy is emerging as a potential treatment of osteoarthritis (OA) and chondral defects (CDs). However, there is a great deal of heterogeneity in the literature. The indications for stem cell use, the ideal tissue source, and the preferred outcome measures for stem cell–based treatments have yet to be determined.

Purpose:
To provide clinicians with a comprehensive overview of the entire body of the current human literature investigating the safety and efficacy of intra-articular mesenchymal stem cell (MSC) therapy in all joints.

Methods:
To provide a comprehensive overview of the current literature, all clinical studies investigating the safety and efficacy of intra-articular MSC therapy were included. PubMed, MEDLINE, and Cochrane Library databases were searched for published human clinical trials involving the use of MSCs for the treatment of OA and CDs in all joints. A total of 3867 publications were screened.

Results:
Twenty-eight studies met the criteria to be included in this review. Fourteen studies treating osteoarthritis and 14 studies treating focal chondral defects were included. MSCs originating from bone marrow (13), adipose tissue (12), synovial tissue (2), or peripheral blood (2) were administered to 584 distinct individuals. MSCs were administered into the knee (523 knees), foot/ankle (61), and hip (5). The mean follow-up time was 24.4 months after MSC therapy. All studies reported improvement from baseline in at least 1 clinical outcome measure, and no study reported major adverse events attributable to MSC therapy.

Discussion:
The studies included in this review suggest that intra-articular MSC therapy is safe. While clinical and, in some cases, radiological improvements were reported for both OA and CD trials, the overall quality of the literature was poor, and heterogeneity and lack of reproducibility limit firm conclusions regarding the efficacy of these treatments.

Conclusion:
This review provides strong evidence that autologous intra-articular MSC therapy is safe, with generally positive clinical outcomes.
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NewsBot · Feb 5, 2021

Hallux rigidus treated with adipose-derived mesenchymal stem cells: A case report
Adriano Braile et al
World J Orthop. 2021 Jan 18;12(1):51-55

Background: First metatarsophalangeal joint arthritis (FMTPA), also known as hallux rigidus, is the most frequent degenerative disease of the foot. Diagnosis is made through both clinical and radiological evaluation. Regenerative medicine showed promising results in the treatment of early osteoarthritis. The aim of the present study was to report the results of a case of FMTPA treated with the injection of autologous adipose-derived mesenchymal stem cells.

Case summary: A gentleman of 50 years of age presented with a painful hallux rigidus grade 2 resistant to any previous conservative treatment (including nonsteroidal anti-inflammatory drugs and hyaluronic acid injections). An injection of autologous adipose-derived mesenchymal stem cells into the first metatarsophalangeal joint was performed. No adverse events were reported, and both function and pain scales improved after 9 mo of follow-up.

Conclusion: The FMTP joint injection of mesenchymal stem cells improved symptoms and function in our patient with FMTPA at 9 mo of follow-up.
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NewsBot · Jul 14, 2022

Autologous Matrix Induced Chondrogenesis plus Peripheral Blood Concentrate (AMIC+PBC) in Chondral Defects of the First Metatarsophalangeal Joint - 5-Year Follow-up
MartinusRichter et al
Foot and Ankle Surgery; 13 July 2022

Background
The aim of the study was to assess the 5-year-follow-up (5FU) after Autologous Matrix Induced Chondrogenesis plus Peripheral Blood Concentrate (AMIC+PBC) in chondral defects at the first metatarsophalangeal joint (MTP1).

Material and Methods
In a prospective consecutive non-controlled clinical follow-up study, all patients with chondral lesion at MTP1 that were treated with AMIC+PBC from April 1, 2009 from July 17, 2016 to May 31, 2017 were included. Size and location of the chondral lesions, the Visual-Analogue-Scale Foot and Ankle (VAS FA) and the EFAS Score before treatment and at 5FU were analysed and compared with previous 2-year-follow-up (2FU). Peripheral Blood Concentrate (PBC) was used to impregnate a collagen I/III matrix (Chondro-Gide, Wolhusen, Switzerland) that was fixed into the chondral lesion with fibrin glue.

Results
One hundred and ninety-eight patients with 238 chondral defects were included. In 21% of patients no deformities in the forefoot were registered. The average degree of osteoarthritis was 2.2. The chondral defect size was 1.0 cm2 on average. The most common location was metatarsal dorsal (33%), and in most patients one defect was registered (74%). Corrective osteotomy of the first metatarsal was performed in 79%. 176 (89%)/164 (83%) patients completed 2FU/5FU. VAS FA/EFAS Score were preoperatively 46.8/11.9 and improved to 74.1/17.1 at 2FU and 75.0/17.3 at 5FU on average. No parameter significantly differed between 2FU and 5FU.

Conclusions
AMIC+PBC as treatment for chondral defects at MTP1 as part of joint preserving surgery led to improved and high validated outcome scores at 2FU and 5FU. The results between 2FU and 5FU did not differ.
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