The meniscus is a crescent-shaped fibrocartilage on the tibia articular surface. Normal meniscus deepens the depression of the tibial condyle and cushions the femur condyle, so as to enhance joint stability, facilitate joint lubrication, and maintain joint function [1,2,3,4,5]. As an essential component for the integrality of the knee joint, the meniscus bears a poor self-healing ability for its intrinsic avascular characteristics [1, 6,7,8]. Only the marginal 10-30% meniscus receives blood supply from the synovial membrane directly and can be healed after injuries, while the central meniscus nourished by the penetration of joint fluid lacks self-healing ability [7,8,9,10].
The annual incidence of meniscus injuries reaches 66-70 per 100,000 people, mainly caused by trauma and degenerative diseases [11,12,13,14,15]. Meniscus injuries lead to multiple clinical symptoms including joint pain, swelling, and locking. It’s estimated 50% of patients with persistent meniscus or anterior cruciate ligament tear will develop osteoarthritis or other articular cartilage degenerative diseases within 10-20 years [16] and the incidence of osteoarthritis will increase up to sevenfold for patients who went through meniscectomy [17]. Thus, meniscus injuries and related degenerative diseases propose a substantial burden to the healthcare system.
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Various surgical therapies were applied to treat meniscus injuries including meniscectomy, allogeneic meniscus transplantation, and artificial meniscus implantation [18,19,20,21,22,23,24]. However, these therapies all bear some drawbacks. For instance, meniscectomy was reported to predispose the knee joint toward osteoarthritis and other degenerative changes [1, 14, 17]. The application of allogeneic meniscus was restricted by limited tissue availability, disease transmission risk, and mismatch between the graft and the host [21, 25, 26]. Concerning artificial meniscus, although the preliminary published data were promising, its long-term therapeutic effect is conflicting [27, 28]. Since no operative therapy for meniscus injury achieved satisfactory outcome currently, attentions were altered to alternative conservative strategies, among which stem cell-based therapy that possesses potent regenerative properties and can promote the natural healing process of the meniscus attracted a lot of interest [29,30,31,32,33].
As a regenerative strategy, stem cell-based therapy has achieved great advances in treating musculoskeletal diseases, such as bone and cartilage defects, osteonecrosis of the femoral head, and intervertebral disk degeneration disease [34,35,36,37,38,39,40]. For meniscus injuries that need reconstruct neo-cartilage, fibrous, and vascularity, stem cells with multidirectional differentiation potentials also hold advantages [30, 32]. Besides, stem cells can not only directly differentiate into meniscus cells but also serve as bioactive factors mediators. Among a variety of sources, mesenchymal stem cells were most explored in treating meniscus injuries for their availability, chemotaxis, and immunomodulatory ability [41,42,43,44]. In this review, we summarize and evaluate the works promoting the application of mesenchymal stem cells (MSCs) in repairing meniscus injuries in the last 5 years. We also highlight the current challenges and unsolved problems before their successful clinical translation. Finally, the prospective and future development of stem cell-based therapy for meniscus injury are also discussed.
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