**4. MSCs in meniscus injury**

Meniscus injury in the knee joint is probably the most frequent intra-articular damage. The typical treatment is a partial surgectomy, but it can lead to degeneration of articular cartilage, narrow joints, and early osteoarthritis. Intra-articular injection of MSCs could be a simple treatment with little damage since MSCs might promote the regeneration of meniscus. Indeed, it was found that when MSCs were injected directly into the articular cavity, they could migrate to the lesion site, directly participate in the tissue repair, and induce the repair of the host through the collateral secretion, and replace the injured tissue [36]. Murhpy et al. reported the first study of injection of BMSCs in sheep articular cavity [37], and observed the obvious repair of cartilage damage in meniscus injury, 6 and 12 weeks after injection. Whitehouse et al. also reported that undifferentiated MSCs/collagen-scaffold implant could provide a safe way to augment avascular meniscal repair in some patients [38]. Another study investigating the injection of allogenic MSCs in the context of post-subtotal meniscectomy found that there was evidence of meniscal regeneration in the two groups treated with MSCs [39]. However, Hong et al. used arthroscopic surgery to repair the meniscus of the posterior articular cavity with or without BMSCs after meniscus injury [40], and found that the meniscus and tibial plateau were not fully integrated, and the efficacy of MSCs treatment group was not significantly different from that of the control group. They argued that MSCs may differentiate into other tissue cells if they were not effectively induced to differentiate into specific cell types. Therefore, it is still a challenge to induce the cells into the meniscus cartilage phenotype in this context.

due to limited clinical case number [46]. Therefore, further high-quality studies for OA with high internal and external validity are still required. In addition, Shi et al. compared the clinical results of platelet-rich plasma (PRP) and MSCs treatments for osteoarthritis of the knee in a systematic review and pointed out MSCS provide more significant disease therapeutic

Auto\_BM\_MSC, Autologous Bone Marrow-derived MSCs. Auto\_AT\_MSC, Autologous Adipose Tissue-derived MSC.

Avascular necrosis of the femoral head (ANFH) is a serious clinical problem. If untreated, about 80% of ANFH progresses to the collapse of the head within 1–4 years [48]. Numerous clinical methods have been tried, including core decompression (CD), a commonly used method for treating the early stages of ANFH. The presumption is that CD can reduce the intraosseous pressure and also stimulate stem cell regeneration. But the outcome of CD is variable and is

With the development of non-biological materials, MSCs and tissue engineering techniques, the treatment of ANFH has been significantly improved recently [49]. For example, it was

effect [47].

a

b

c

still controversial.

**6. MSCs in femoral head necrosis**

**References Location BMCSa Follow-up** 

BM\_MSC

AT\_MSC

BM\_MSC

BM\_MSC

BM\_MSC

The WOMAC index (pain subscale) has been used; scale 0–100.

The VAS index (pain subscale) has been used; scale 0–10.

**Table 1.** Summary of MSCs as the treatment of osteoarthritis.

[41] knee Auto\_

[42] knee Auto\_

[43] knee Allo\_

[44] knee Auto\_

[45] Hip Auto\_

Allogeneic Bone Marrow-derived MSC.

**time**

**No. of cases** **Pain subscale Outcomes**

http://dx.doi.org/10.5772/intechopen.76868

**values**

improvement, higher cartilage quality (MRI)

215

improvements

improvement, higher cartilage quality (MRI)

improvement, higher cartilage quality (MRI)

improvement, improved function

**Pre-infusion values Post-infusion** 

Clinical Applications of Mesenchymal Stromal Cells (MSCs) in Orthopedic Diseases

1 year 12 24 ± 14b 6 ± 6b pain

6 months 12 56 ± 19b 34 ± 23b clinical

1 year 15 46 ± 15b 30 ± 16b pain

24 weeks 2 4c 0.38c pain

3 years 10 34.5 ± 8.2b 19.2 ± 6.1b pain
