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Systematic Review

Methodological Flaws in Meta-Analyses of Clinical Studies on the Management of Knee Osteoarthritis with Stem Cells: A Systematic Review

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Chair of Anatomy II, Institute of Anatomy, Faculty of Medicine, Ludwig-Maximilians University, 80336 Munich, Germany
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Isar Klinikum, General Management, 80331 Munich, Germany
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InGeneron Inc., Houston, TX 77054, USA
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Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD 57105, USA
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Sanford Health, Sioux Falls, SD 57117, USA
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Sanford Research, Sioux Falls, SD 57105, USA
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SUN Orthopedics of Evangelical Community Hospital, Lewisburg, PA 17837, USA
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Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084 Fisciano, Italy
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Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, London E1 2AD, UK
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School of Pharmacy and Bioengineering, Guy Hilton Research Centre, Keele University School of Medicine, Stoke on Trent ST4 7QB, UK
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Heart and Vascular Institute, Department of Medicine, Tulane University Health Science Center, New Orleans, LA 70112, USA
*
Author to whom correspondence should be addressed.
Academic Editor: Lukas Prantl
Cells 2022, 11(6), 965; https://doi.org/10.3390/cells11060965
Received: 17 February 2022 / Revised: 8 March 2022 / Accepted: 9 March 2022 / Published: 11 March 2022
(This article belongs to the Special Issue Regeneration of Tissue with Mesenchymal Stem Cells)
(1) Background: Conclusions of meta-analyses of clinical studies may substantially influence opinions of prospective patients and stakeholders in healthcare. Nineteen meta-analyses of clinical studies on the management of primary knee osteoarthritis (pkOA) with stem cells, published between January 2020 and July 2021, came to inconsistent conclusions regarding the efficacy of this treatment modality. It is possible that a separate meta-analysis based on an independent, systematic assessment of clinical studies on the management of pkOA with stem cells may reach a different conclusion. (2) Methods: PubMed, Web of Science, and the Cochrane Library were systematically searched for clinical studies and meta-analyses of clinical studies on the management of pkOA with stem cells. All clinical studies and meta-analyses identified were evaluated in detail, as were all sub-analyses included in the meta-analyses. (3) Results: The inconsistent conclusions regarding the efficacy of treating pkOA with stem cells in the 19 assessed meta-analyses were most probably based on substantial differences in literature search strategies among different authors, misconceptions about meta-analyses themselves, and misconceptions about the comparability of different types of stem cells with regard to their safety and regenerative potential. An independent, systematic review of the literature yielded a total of 183 studies, of which 33 were randomized clinical trials, including a total of 6860 patients with pkOA. However, it was not possible to perform a scientifically sound meta-analysis. (4) Conclusions: Clinicians should interpret the results of the 19 assessed meta-analyses of clinical studies on the management of pkOA with stem cells with caution and should be cautious of the conclusions drawn therein. Clinicians and researchers should strive to participate in FDA and/or EMA reviewed and approved clinical trials to provide clinically and statistically valid efficacy. View Full-Text
Keywords: meta-analyses; primary knee osteoarthritis; stem cells; systematic review meta-analyses; primary knee osteoarthritis; stem cells; systematic review
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MDPI and ACS Style

Schmitz, C.; Alt, C.; Pearce, D.A.; Furia, J.P.; Maffulli, N.; Alt, E.U. Methodological Flaws in Meta-Analyses of Clinical Studies on the Management of Knee Osteoarthritis with Stem Cells: A Systematic Review. Cells 2022, 11, 965. https://doi.org/10.3390/cells11060965

AMA Style

Schmitz C, Alt C, Pearce DA, Furia JP, Maffulli N, Alt EU. Methodological Flaws in Meta-Analyses of Clinical Studies on the Management of Knee Osteoarthritis with Stem Cells: A Systematic Review. Cells. 2022; 11(6):965. https://doi.org/10.3390/cells11060965

Chicago/Turabian Style

Schmitz, Christoph, Christopher Alt, David A. Pearce, John P. Furia, Nicola Maffulli, and Eckhard U. Alt. 2022. "Methodological Flaws in Meta-Analyses of Clinical Studies on the Management of Knee Osteoarthritis with Stem Cells: A Systematic Review" Cells 11, no. 6: 965. https://doi.org/10.3390/cells11060965

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