Restoration of a large osteochondral defect of the knee using a composite of umbilical cord blood-derived mesenchymal stem cells and hyaluronic acid hydrogel: a case report with a 5-year follow-up

BMC Musculoskelet Disord. 2017 Feb 2;18(1):59. doi: 10.1186/s12891-017-1422-7.


Background: The treatment of articular cartilage defects is a therapeutic challenge for orthopaedic surgeons. Furthermore, large osteochondral defects needs restoration of the underlying bone for sufficient biomechanical characteristics as well as the overlying cartilage.

Case presentation: A symptomatic large osteochondral defect in the knee joint was restored using a composite of umbilical cord blood-derived mesenchymal stem cells (UCB-MSCs) 0.5 x 107/ml and 4% hyaluronic acid (HA) hydrogel. Significant improvements in pain and function of the knee joint were identified by the evaluation at 12 months after surgery. A hyaline-like cartilage completely filled the defect and was congruent with the surrounding normal cartilage as revealed by magnetic resonance imaging (MRI), a second-look arthroscopy and histological assessment. The improved clinical outcomes maintained until 5.5 years. MRI also showed the maintenance of the restored bony and cartilaginous tissues.

Conclusion: This case report suggests that the composite of allogeneic UCB-MSCs and HA hydrogel can be considered a safe and effective treatment option for large osteochondral defects of the knee.

Keywords: Hyaluronic acid; Knee; Large osteochondral defect; Mesenchymal stem cell; Umbilical cord blood.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Arthroscopy
  • Cartilage, Articular / diagnostic imaging
  • Cartilage, Articular / pathology
  • Cartilage, Articular / surgery*
  • Cord Blood Stem Cell Transplantation / methods*
  • Female
  • Femur / diagnostic imaging
  • Femur / pathology
  • Femur / surgery*
  • Follow-Up Studies
  • Humans
  • Hyaluronic Acid / administration & dosage
  • Hyaluronic Acid / therapeutic use*
  • Hydrogels / chemical synthesis
  • Knee Joint / diagnostic imaging
  • Knee Joint / pathology
  • Knee Joint / surgery*
  • Magnetic Resonance Imaging
  • Meniscectomy
  • Mesenchymal Stem Cell Transplantation / methods*
  • Pain Management / methods
  • Pain Measurement
  • Radiography
  • Second-Look Surgery
  • Tibial Meniscus Injuries / surgery
  • Transplantation, Homologous / methods


  • Hydrogels
  • Hyaluronic Acid