Editorial Commentary: Biologics for Knee Cartilage Regeneration Show Modest Symptom-Reducing Efficacy.

Biologic solutions for articular cartilage degeneration and focal chondral defects show modest symptom-reducing efficacy using bone marrow aspirate concentrate, adipose-derived stem cells, and platelet-rich plasma. However, regrowth of healthy hyaline cartilage within diseased areas remains elusive. Recent research proposes allogenic human umbilical cord blood-derived mesenchymal stem cells as another cell-based biologics approach. A benefit of this technique would be the availability of viable "off-the-shelf" undifferentiated cells, obviating the need for bone marrow aspiration or adipose cell harvest. Findings included improved Magnetic Resonance Observation Cartilage Repair Tissue, which correlated negatively with defect size and improved patient-reported outcomes in terms of symptom reduction. High tibial osteotomy, which is known to result in improved outcomes in patients with cartilage degeneration (and malalignnment), is a confounder. This illustrates the importance of evaluating and treating the whole knee, and the whole patient, including extremity alignment, meniscal status, stability, body mass, and the synovial fluid environment. Cell-based treatments may be a piece of that puzzle. In addition to indeterminate outcomes and indications, barriers to adoption include cost and access.