Evaluation of intra-articular mesenchymal stem cells to augment healing of microfractured chondral defects

Arthroscopy. 2011 Nov;27(11):1552-61. doi: 10.1016/j.arthro.2011.06.002. Epub 2011 Aug 20.


Purpose: This study evaluated intra-articular injection of bone marrow-derived mesenchymal stem cells (BMSCs) to augment healing with microfracture compared with microfracture alone.

Methods: Ten horses (aged 2.5 to 5 years) had 1-cm2 defects arthroscopically created on both medial femoral condyles of the stifle joint (analogous to the human knee). Defects were debrided to subchondral bone followed by microfracture. One month later, 1 randomly selected medial femorotibial joint in each horse received an intra-articular injection of either 20 × 10(6) BMSCs with 22 mg of hyaluronan or 22 mg of hyaluronan alone. Horses were confined for 4 months, with hand walking commencing at 2 weeks and then increasing in duration and intensity. At 4 months, horses were subjected to strenuous treadmill exercise simulating race training until completion of the study at 12 months. Horses underwent musculoskeletal and radiographic examinations bimonthly and second-look arthroscopy at 6 months. Horses were euthanized 12 months after the defects were made, and the affected joints underwent magnetic resonance imaging and gross, histologic, histomorphometric, immunohistochemical, and biochemical examinations.

Results: Although there was no evidence of any clinically significant improvement in the joints injected with BMSCs, arthroscopic and gross evaluation confirmed a significant increase in repair tissue firmness and a trend for better overall repair tissue quality (cumulative score of all arthroscopic and gross grading criteria) in BMSC-treated joints. Immunohistochemical analysis showed significantly greater levels of aggrecan in repair tissue treated with BMSC injection. There were no other significant treatment effects.

Conclusions: Although there was no significant difference clinically or histologically in the 2 groups, this study confirms that intra-articular BMSCs enhance cartilage repair quality with increased aggrecan content and tissue firmness.

Clinical relevance: Clinical use of BMSCs in conjunction with microfracture of cartilage defects may be potentially beneficial.

Publication types

  • Comparative Study
  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Arthroplasty, Subchondral*
  • Arthroscopy
  • Bone Marrow Transplantation*
  • Cartilage / injuries*
  • Cartilage / pathology
  • Cartilage / physiology
  • Cartilage / surgery*
  • Combined Modality Therapy
  • Horses
  • Hyaluronic Acid / therapeutic use
  • Injections, Intra-Articular
  • Intra-Articular Fractures
  • Knee Injuries / diagnostic imaging
  • Knee Injuries / pathology
  • Knee Injuries / surgery*
  • Magnetic Resonance Imaging
  • Mesenchymal Stem Cell Transplantation*
  • Models, Animal
  • Orthopedic Procedures / methods*
  • Radiography
  • Random Allocation
  • Single-Blind Method
  • Stifle / injuries
  • Stifle / physiology
  • Synovial Membrane / pathology
  • Treatment Outcome
  • Viscosupplements / therapeutic use
  • Wound Healing*


  • Viscosupplements
  • Hyaluronic Acid