Mesenchymal Stem Cells in Pediatric Physeal Growth Arrest: A Systematic Review

The physeal growth plate is a common site of involvement in pediatric and adolescent fractures, with 18-30% of fractures complicated by physis injury potentially leading to growth plate arrest and formation of a bony bar (BB). Inadequate treatment of growth arrest in children can cause long-term complications such as limb-length discrepancies or angular deformities. Stem cell transplantation has been increasingly studied as a potential treatment modality for growth arrest and prevention of BB formation in physeal injuries. The purpose of this study is to summarize the current state of literature on the ability of stem cells to prevent physeal growth arrest, determine the ideal stem cell type for use in physeal injuries, and analyze the methods of stem cell delivery and biochemical environment necessary for stem cell therapy success. This study is a systematic review. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were utilized to search PubMed including the terms "growth plate arrest", "physeal injury", "physeal", "growth plate injury", "bony bar", "stem cell", "mesenchymal", and "chondrocyte" from 2012-2024 and then independently analyzed by three reviewers. Studies were excluded if they were off topic, bench-top studies, editorials, non-English, or did not include a focus on stem cells. The search identified 269 potential articles, 68 remained after applying exclusion criteria, and eight were included after reviewer analysis. No studies in human models remained. Based on the findings of this systematic review, the use of mesenchymal stem cells and chondrocytes, when compared to controls, is associated with a decrease in bony deformities following injury to an open physeal growth plate in animal models. However, there is considerable variability in the literature on the method of stem cell transplantation and which combination of cells provides the greatest benefit. Given the high likelihood of limb deformity following pediatric or adolescent growth arrest injuries, utilizing mesenchymal stem cells to prevent growth arrest and BB formation would significantly impact the field of pediatric orthopedics. Stem cells have demonstrated the potential to improve outcomes in physeal plate injury in animal models; however, further research is needed to determine the ideal methods and biochemical environment required for successful stem cell therapy in humans.