A New Advanced Osteoarthritis Treatment Utilizing Modified Mesenchymal Stem Cells: Arthroscopic Guided Intra-Articular Intervention Approach a Systematic Review and Meta-Analysis

BackgroundThe mesenchymal stem cells (MSCs) is able to regenerate the cartilage defect caused by osteoarthritis (OA) to prevent permanent disability. Its efficacy may be even greater in combination with platelet-rich plasma (PRP) and hyaluronic acid (HA). Thus, this systematic review aimed to investigate the efficacy of MSCs in combination with PRP and adjusted doses of HA, the best source of MSCs, and the optimal number of applied MSCs to treat osteoarthritis as a cartilage regenerative agent. MethodThe sources included were original articles published from 2013 until 2023 from 4 databases (Pubmed, Springerlink, ScienceDirect, and Google Scholar). Studies included were original research of clinical trials or randomized controlled trials. Irrelevant studies were excluded. Then, the ROB-2 taken was used to assess bias. The result was constructed with PICOS criteria within the table created in the Google spreadsheet. MRI score, VAS score, Lysholm score, Cartilage volume, size of cartilage defect, Knee Society Clinical Rating System Score (KSS), and WOMAC index to evaluate treatments effication outcomes were analyzed by Revman 5.4. This systematic review followed the PRISMA guidelines. Resultnine studies were included in the final screening. The meta-analysis showed a significant (P < 0.00001) elevation of Lysholm score with a pooled mean difference (MD) of (17.89) (95% CI: 16.01, 19.77; I2 = 0%, P = 0.56); a significant reduction (P < 0.00001) of VAS score with a pooled MD of (-2.62) (95% CI: -2.83, -2.41; I2 = 99%, P <0.00001); Knee society clinical rating system score (KSS) evaluation also showed significant elevation (P< 0.00001) with mean polled (29.59) (95% CI: 27.66, 31.52; I2= 95%, P< 0.0001); and significantly reduction (P<0.00001) of WOMAC score occurred as pooled MD of (-12.38) (95% CI: -13.75, -11.01; I2= 99%, P< 0.0001). ConclusionsArthroscopic guided high-dose subchondral application of primary cultured synovial mesenchymal stem cells in popliteal platelet-rich plasma media combined with hyaluronic acid effectively regenerate cartilage defect and increase clinical outcomes in the early stage of osteoarthritis. Level of EvidenceTherapeutic Level I.