{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T10:23:24Z","timestamp":1792664604150,"version":"4.5.0"},"reference-count":49,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2021,1,1]],"date-time":"2021-01-01T00:00:00Z","timestamp":1609459200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Journal of Sports Medicine"],"published-print":{"date-parts":[[2021,1,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>There is currently no optimal method for cartilage restoration in large, full-thickness cartilage defects in older patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To determine whether implantation of a composite of allogeneic umbilical cord blood\u2013derived mesenchymal stem cells and 4% hyaluronate (UCB-MSC-HA) will result in reliable cartilage restoration in patients with large, full-thickness cartilage defects and whether any clinical improvements can be maintained up to 5 years postoperatively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Randomized controlled trial; Level of evidence, 1.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A randomized controlled phase 3 clinical trial was conducted for 48 weeks, and the participants then underwent extended 5-year observational follow-up. Enrolled were patients with large, full-thickness cartilage defects (International Cartilage Repair Society [ICRS] grade 4) in a single compartment of the knee joint, as confirmed by arthroscopy. The defect was treated either with UCB-MSC-HA implantation through mini-arthrotomy or with microfracture. The primary outcome was proportion of participants who improved by \u22651 grade on the ICRS Macroscopic Cartilage Repair Assessment (blinded evaluation) at 48-week arthroscopy. Secondary outcomes included histologic assessment; changes in pain visual analog scale (VAS) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and International Knee Documentation Committee (IKDC) score from baseline; and adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Among 114 randomized participants (mean age, 55.9 years; 67% female; body mass index, 26.2 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ), 89 completed the phase 3 clinical trial and 73 were enrolled in the 5-year follow-up study. The mean defect size was 4.9 cm\n                      <jats:sup>2<\/jats:sup>\n                      in the UCB-MSC-HA group and 4.0 cm\n                      <jats:sup>2<\/jats:sup>\n                      in the microfracture group ( P = .051). At 48 weeks, improvement by \u22651 ICRS grade was seen in 97.7% of the UCB-MSC-HA group versus 71.7% of the microfracture group ( P = .001); the overall histologic assessment score was also superior in the UCB-MSC-HA group ( P = .036). Improvement in VAS pain, WOMAC, and IKDC scores were not significantly different between the groups at 48 weeks, however the clinical results were significantly better in the UCB-MSC-HA group at 3- to 5-year follow-up ( P &lt; .05). There were no differences between the groups in adverse events.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>In older patients with symptomatic, large, full-thickness cartilage defects with or without osteoarthritis, UCB-MSC-HA implantation resulted in improved cartilage grade at second-look arthroscopy and provided more improvement in pain and function up to 5 years compared with microfracture.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Registration:<\/jats:title>\n                    <jats:p>NCT01041001, NCT01626677 (ClinicalTrials.gov identifier).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/2325967120973052","type":"journal-article","created":{"date-parts":[[2021,1,14]],"date-time":"2021-01-14T20:54:13Z","timestamp":1610657653000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":105,"title":["Allogeneic Umbilical Cord Blood\u2013Derived Mesenchymal Stem Cell Implantation Versus Microfracture for Large, Full-Thickness Cartilage Defects in Older Patients: A Multicenter Randomized Clinical Trial and Extended 5-Year Clinical Follow-up"],"prefix":"10.1177","volume":"9","author":[{"given":"Hong-Chul","family":"Lim","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Korea University Guro Hospital, Korea University School of Medicine, Seoul, Republic of Korea."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong-Beom","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chul-Won","family":"Ha","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea."},{"name":"Stem Cell & Regenerative Medicine Institute, Samsung Medical Center, Seoul, Republic of Korea."},{"name":"Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian J.","family":"Cole","sequence":"additional","affiliation":[{"name":"Department of Orthopedics Cartilage Restoration Center, Departments of Orthopedics and Surgery, Midwest Orthopedics, Rush University Medical Center, Chicago, Illinois, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beom-Koo","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Gachon University Gil Hospital, Gachon University School of Medicine, Incheon, Republic of Korea."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hwa-Jae","family":"Jeong","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myung-Ku","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Inha University Hospital, Inha University School of Medicine, Incheon, Republic of Korea."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seong-Il","family":"Bin","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Asan Medical Center, Ulsan University School of Medicine, Seoul, Republic of Korea."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chong-Hyuk","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University School of Medicine, Seoul, Republic of Korea."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Choong Hyeok","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Hanyang University Medical Center, Hanyang University School of Medicine, Seoul, Republic of Korea."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jae-Doo","family":"Yoo","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Republic of Korea."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the Cartistem Research 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