Injectable Autologous Bone-Marrow-Derived Mesenchymal Stem Cells for Cartilage Repair: The Singapore Technique

The cartilage, which is mesodermal in origin, provides excellent lubrication and wear characteristics required for continuous gliding motion. It serves to absorb mechanical shock and spread the applied load onto the bony supporting structures below. But its limited capacity for repair can cause severe and progressive disability of the joint, such as osteoarthritis. Osteoarthritis is the leading cause of chronic disability in large developed countries like the United States, and Singapore is no exception. According to the Singapore Ministry of Health National Health Surveillance, 10.1 % of residents between the ages of 18 and 69 have arthritis and chronic joint symptoms. The prevalence increased with age and was highest among older residents aged 60–69 years (19.8 %). At present, current treatments reduce pain and inflammation, but do not retard the destruction of cartilage. One of the most well-known and utilized treatments is the total knee replacement (TKR). While it has been successful for the older, less-active patient, the degradation of these replacements over time makes it less suitable for younger active patients. As TKRs usually last for no more than 20 years, they are only recommended for patients greater than 60 years of age. Among older adults in the United States, nearly 1.5 million of those with a primary total knee replacement are 50–69 years old, indicating a large population is at risk for cost revision surgery and long-term complications of total knee replacement. This has called for a look into the viability of stem cell engineering as a solution.