Good mid-term outcomes after adipose-derived culture-expanded mesenchymal stem cells implantation in knee focal cartilage defects

  • Theofylaktos Kyriakidis
  • Michael IosifidisEmail author
  • Efstathios Michalopoulos
  • Ioannes Melas
  • Catherine Stavropoulos-Giokas
  • René Verdonk



The purpose of the present study was to investigate the mid-term outcomes of a single-stage cell-based procedure in patients with knee focal symptomatic cartilage defects using matrix-induced culture-expanded autologous AD-MSCs. It was hypothesised that the increased number of autologous AD-MSCs after culture expansion is a safe and efficient cartilage repair procedure, which improves overtime chondrogenesis in cartilage lesions


Twenty-five consecutive patients treated for a symptomatic cartilage defect were prospectively followed for 3 years. The median age of patients was 30.5 (range 16–43) with a median BMI of 23.6 kg/m2 (range 19–29) and an average size of the lesion of 3.5 cm2 (range 2–6). All patients underwent a single-stage procedure consisting in filling each defect with autologous culture-expanded mesenchymal stem cells embedded in a trimmed-to-fit commercially available biodegradable matrix. Pre-operative and post-operative evaluation included knee-related clinical and functional evaluation based on objective and subjective scores at 6, 12, 24 and 36 months and MRI evaluation of the repair tissue using the MOCART score at 12 and 24 months.


Clinical outcomes recorded significant improvements (p < 0.05) at the final follow-up compared with baseline as following: all subcategories of KOOS Score, the IKDC subjective from 40.9 (range 20.7–65.6) to 76.9 (range 42–90.3), Tegner Activity Score from 3 (range 2–4) to 4 (range 3–4), VAS for pain from 6 (range 4–8) to 1 (range 0–3). All patients improve significantly their IKDC objective scores. The MRI findings showed complete filling of the defect and integration to the border zone for 65% of the patients. Two patients underwent post-operative biopsies and the histological analysis demonstrated the presence of hyaline-like tissue.


Adipose-derived culture-expanded mesenchymal stem cells were shown to be an efficient and safe single-stage cell-based procedure for symptomatic, full-thickness knee chondral lesions. The findings of the present study demonstrate that all patients presented significant mid-term clinical, functional and radiological improvement.

Level of evidence



Chondral lesion Adipose-derived stem cells Cartilage repair Regenerative medicine Tissue engineering Scaffolds Cell culture expansion 



The authors are grateful to the radiologist Afarine Madani MD, PhD for her contribution in MR images evaluation.

Author contributions

TK: data collection, writing and critical review of the paper; IM: performed surgeries, data collection, writing and critical review of the paper; EM: performed culture isolation; IM: data collection, writing the paper; CSG: performed culture isolation; RV: critical review of the paper; TK and MI have contributed equally to this article and share first authorship.


The authors received no financial support for the research, authorship and/or publication of this article.

Compliance with ethical standards

Conflict of interest

The authors declared no potential conflict of interest with respect to the research, authorship and/or publication of this article.

Ethical approval

Ethical approval for this study was approved by the Bioethics Committee of the Aristotle University of Thessaloniki (1.4.2013/34).

Informed consent

Written informed consent was obtained from all subjects before the study.


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  1. 1.Department of Orthopaedic Surgery and Traumatology, Erasme University HospitalUniversité Libre de BruxellesBrusselsBelgium
  2. 2.OrthoBiology Surgery CenterThessaloníkiGreece
  3. 3.Hellenic Cord Blood Bank, Biomedical Research Foundation Academy of AthensAthensGreece

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