Review Article

Advances and Prospects in Stem Cells for Cartilage Regeneration

Table 1

Recent clinical trials involving stem cells in cartilage regeneration.

Cell typeCell sourceLocationInjury typeCell carrierCases ()Follow-upDescriptionResultsReferences

CDPCsAutologous, cartilage-derivedKnee ACCartilage defectsCollagen type I/III scaffold1512 monthsCompared with BMSCs, the chondrogenic potential was betterEctopic calcification and vascularization were not found in tissue biopsies of four patients. The clinical scores of all patients showed improvement; function improved and pain was relieved.2016 [24]

BMSCsAutologousKnee ACOAInjection35 yearsUpdate of a previous studyLong-term follow-up of stem cell injection showed good prognosis for patients with early-stage OA.2016 [28]

BMSCsAllogenicKnee ACOAInjectionBMSCs: 15
HA: 15
12 monthsRCTCompared to the HA group, the function recovery and quality of regenerated cartilage are meaningfully enhanced in the BMSC group.2015 [29]

BMSCsAllogenicKnee AC and meniscusOAInjectionLow-dose: 18
High-dose: 18
HA: 19
2 yearsPartial medial meniscectomy RCTKnee joint pain was relieved, and MRI showed meniscus regeneration in the stem cell group.2014 [30]

BMSCsAutologousKnee ACOAInjection122 yearsUpdate of a previous studyPain was relieved after 1 year of treatment, which continued through year 2. MRI showed better quality of cartilage in year 2 compared to year 1.2014 [31]

BMSCsAutologousKnee ACOA Cartilage defectsInjectionHA + BMSCs: 28
HA: 28
2 yearsRCT high tibial osteotomy + microfractureEffectively improving both short-term clinical and cartilage repair tissue scores.2013 [32]

BMSCsAutologousAnkleChondral defectsCollagen membrane252 yearsMatrix-associated stem cell transplantationGood clinical scores and no complications.2013 [33]

BMSCsAutologousKnee ACCartilage defectsInjection periosteal patchMicrofracture + BMSCs + HA: 35
BMSCs + patch: 35
2 yearsMicrofracture + BMSCs + HA are comparable to BMSCs + patch, but minimally invasive.2012 [34]

SMSCsAutologousKnee AC + meniscusCartilage defectsArthroscopic transplantation1037–80 months10% autologous human serum used to expand cellsMRI scores, Lysholm score, and qualitative histology all show that SMSC transplantation is meaningful.2015 [35]

ADSCsAutologousKnee ACCartilage defectsArthroscopicADSCs + microfracture + fibrin glue: 40
Microfracture: 40
2 yearsRCTRadiologic and KOOS pain and symptom scores show a more meaningful improvement than that of the control group.2016 [36]

ADSCsAutologousKnee ACOAArthroscopicADSCs + fibrin glue: 202 yearsClinical and MRI scores show a significant improvement.2016 [37]

ADSCsAutologousKnee ACOAInjectionSVF: 1,12812–54 monthsNo serious side effects, infection, or cancer related to SVF.2015 [38]

ADSCsAutologousKnee ACOAInjection302 years4.04 × 106 stem cellsEffective for elderly patients with OA at the knee.2015 [39]

ADSCsAutologousKnee ACOAArthroscopicADSCs: 37
ADSCs + fibrin glue: 17
24–34 monthsArthroscopic and clinical outcomes were useful for OA in both groups. However, the ADSC + fibrin glue group had better ICRS scores.2015 [40]

ADSCsAutologousKnee ACEarly OAArthroscopicADSCs + fibrin glue: 49Mean 26.7 monthsPatients > 60 years of age or having injury areas < 6 cm2 were not suitable for this treatment.2015 [41]

ADSCsAutologousMeniscusMeniscal tearInjectionADSCs + PRP + CaCl2 + HA: 118 monthsPain was alleviated. MRI at 3 months after treatment showed that the meniscal tear had almost disappeared.2014 [42]

ADSCsAutologousKnee ACOAArthroscopicKnee: 3724–34 monthsThe factors affecting the repair result were mostly large injury area and high BMI. The second arthroscopic view showed 76% nonregular repair.2014 [43]

ADSCsAutologousTalus Osteochondral lesionsInjectionMarrow stimulation: 26
SVF + marrow stimulation: 24
21.9 monthsMarrow stimulation with SVF group showed better results than the marrow stimulation alone group.2014 [44]

ADSCsAutologousKnee ACOAInjectionI: low-dose (3), medium-dose (3), high-dose (3)
II: high-dose (9)
6 monthsLow dose: 1 × 107 Medium dose: 5 × 107 High dose: 1 × 108No adverse events. The high-dose group showed better results than the other groups.2014 [45]

ADSCsAutologousKnee ACOAInjectionADSCs + PRP: 9130 monthsSafety of autologous SVF and percutaneous local injections was demonstrated by MRI and telephone follow-up.2013 [46]

ADSCsAutologousKnee ACOAInjectionSVF + PRP: 1824–26 monthsADSCs of the infrapatellar fat pad were useful for relieving articular pain and improving knee joint function.2013 [47]

ADSCsAutologousTalusOsteochondral lesionsInjectionMicrofracture: 30
Microfracture + ADSCs: 35
21.8 monthsAmong patients above 50 years of age, the effect of marrow stimulation + ADSCs was better than marrow stimulation alone. >109 mm2 lesion size and existing subchondral cyst showed better regeneration results.2013 [48]

ADSCsAutologousKnee ACOAInjectionADSCs + PRP: 2512 months1.89 × 106 ADSCs, 3 mL PRPADSCs of the infrapatellar fat pad were useful for releasing articular pain and improving knee joint function.2012 [49]

PBSCsAutologousKnee ACChondral lesionsOpen surgery17.5 yearsPeriosteal flap + patellofemoral realignmentCT and MRI showed better results. Eight months after the surgery, the second arthroscopy showed that the new-growth cartilage had a smooth surface. The patient returned to practicing Taekwondo.2014 [50]

PBSCsAutologousKnee ACEarly OAInjection56 monthsPBSCs + HA + growth factor + microfractureNo adverse events and all clinical scores improved.2013 [51]

PBSCsAutologousKnee ACChondral defectsArthroscopicMicrofracture + HA: 25
PBSCs + microfracture + HA: 25
2 yearsRCTPBSC group has a better quality of newborn cartilage than the control group on histological and MRI assessments.2013 [52]

PBSCsAutologousKnee ACChondral defectsOpen surgery526 yearsCollagen membranePBSCs are an effective way to repair large cartilage lesions. This method can be used as an alternative to ACI.2012 [53]