The role of mesenchimal stem cells in the treatment of osteochondral lesions and osteoarthritis of the ankle

INTRODUCTION: Pathologies affecting the articular cartilage of the ankle, both degenerative and traumatic, are a common cause of chronic pain and disability unrelated to aging. Traditional therapies aim at controlling symptoms and slowing the progression of the disease, with ankle joint replacement as a final option for end-stage arthritis. The orthobiological approach represents the last frontier in the treatment of degenerative disorders of articular cartilage in different joints. In fact, the recent use of mesenchymal stem cells (MSCs) harvested from bone marrow or adipose tissue may represent a novel therapeutic aproach due their potential immunomodulatory and anti-fibrotic effects and, being autologous, they do not trigger the immune response. Moreover, it is also easy to collect these cells from the donor site. Thus, the main aim of this review is to evaluate the state of the art on ankle pathologies treated with stem cells. EVIDENCE ACQUISITION: To fulfill the purpose of this review study, a literature search was performed via Pubmed and Google scholar, finally including 14 clinical trials, 7 reviews and 2 book chapters. Studies about ankle diseases are few compared to the amount of studies about knee. EVIDENCE SYNTHESIS: Current literature has shown clinical safety and promising short-term effectiveness of MSC-based treatments for both osteochondral lesions and osteoarthritis of the ankle, suggestin them as a viable option and a valid alternative to traditional approaches. CONCLUSIONS: The use of stem cells in ankle disorders certainly represents a valid alternative to traditional therapies given the satisfactory results and the lack of adverse events related to their use. However, given the poorness of works dedicated to the ankle, as opposed to the greater attention placed on the knee, more studies will be needed to evaluate the effectiveness of stem cell therapy in the long term.