Mesenchymal stem cells isolated from both distal femurs of patients with unilateral trauma or osteoarthritis of the knee exhibit similar in-vitro ability of bone formation.

BACKGROUND: Bone fractures are a common cause of hospital admission. Currently, treatment consists of conservative regimens or operation. However, regenerative medicine introduces a possible new addition to established treatments. Evidence suggests that application of autologous mesenchymal stem cells can enhance bone regeneration, by differentiating into osteoblasts. This study investigates whether mesenchymal stem cells, isolated from bone marrow in sites of trauma or osteoarthritis, exhibit reduced proliferation and osteogenic differentiation in-vitro, compared to stem cells isolated from non-traumatic and non-osteoarthritic sites. If these pathologies are detrimental to the quality, clinicians should prioritize bone marrow from unafflicted sites. METHODS: 17 patients were enrolled. 7 had recent unilateral trauma to the knee, requiring arthroscopy. 10 had x-ray verified unilateral osteoarthritis of the knee and were scheduled for arthroplasty. Stem cells were isolated from bone marrow aspirated perioperatively from both distal femurs. In-vitro osteogenic activity was assessed through alkaline phosphatase measurement, RNA-expression and alizarin red staining. Proliferation was measured using a growth curve. RESULTS: 29 out of 34 primary cultures were successful, forming colonies with characteristic stem cell-morphology. There was no difference in mononuclear cell yield of aspirates or stem cell-yield from primary culture between non-osteoarthritic and arthritic knees or non-traumatic and traumatic knees. There was no significant difference in in-vitro osteogenic capability or proliferation. CONCLUSION: Our findings suggest that stem cells from sites afflicted by osteoarthritis or trauma can be utilized for bone regeneration with identical results as MSCs isolated from non-traumatic and non-osteoarthritic sites. However, clinical studies are needed to confirm this assumption.

Large regional differences in incidence of arthroscopic meniscal procedures in the public and private sector in Denmark.

OBJECTIVES: A recent study reported a large increase in the number of meniscal procedures from 2000 to 2011 in Denmark. We examined the nation-wide distribution of meniscal procedures performed in the private and public sector in Denmark since different incentives may be present and the use of these procedures may differ from region to region. SETTING: We included data on all patients who underwent an arthroscopic meniscal procedure performed in the public or private sector in Denmark. PARTICIPANTS: Data were retrieved from the Danish National Patient Register on patients who underwent arthroscopic meniscus surgery as a primary or secondary procedure in the years 2000 to 2011. Hospital identification codes enabled linkage of performed procedures to specific hospitals. PRIMARY AND SECONDARY OUTCOME MEASURES: Yearly incidence of meniscal procedures per 100,000 inhabitants was calculated with 95% CIs for public and private procedures for each region. RESULTS: Incidence of meniscal procedures increased at private and at public hospitals. The private sector accounted for the largest relative and absolute increase, rising from an incidence of 1 in 2000 to 98 in 2011. In 2011, the incidence of meniscal procedures was three times higher in the Capital Region than in Region Zealand. CONCLUSIONS: Our study identified a large increase in the use of meniscal procedures in the public and private sector in Denmark. The increase was particularly conspicuous in the private sector as its proportion of procedures performed increased from 1% to 32%. Substantial regional differences were present in the incidence and trend over time of meniscal procedures.