The integration of stem cell technology and cell sheet engineering improved the potential use of cell sheet products in regenerative medicine. This review will discuss the use of mesenchymal stem cells (MSCs) in cell sheet-based tissue engineering. Besides their adhesiveness to plastic surfaces and their extensive differentiation potential in vitro, MSCs are easily accessible, expandable in vitro with acceptable genomic stability, and few ethical issues. With all these advantages, they are extremely well suited for cell sheet-based tissue engineering. This review will focus on the use of MSC sheets in osteogenic tissue engineering. Potential application techniques with or without scaffolds and/or grafts will be discussed. Finally, the importance of osteogenic induction of these MSC sheets in orthopaedic applications will be demonstrated.

In a prospective randomized study of plantar heel pain, 44 patients were treated with injection of 1 mL of 2% prilocaine using the peppering technique, 1 mL of 2% prilocaine combined with 2 mL of autologous blood, or 1 mL of 2% prilocaine mixed with 40 mg of methylprednisolone acetate. At 6-month follow-up, clinical improvement was evaluated by using a 10-cm visual analog scale and the rearfoot score of the American Orthopaedic Foot and Ankle Society. Results were analyzed using sample t -tests within groups and repeated-measures analyses of variance between groups. Mean ± SD visual analog scale scores in the peppering technique, autologous blood injection, and corticosteroid injection groups improved from 6.4 ± 1.1, 7.6 ± 1.3, and 7.28 ± 1.2 to 2.0 ± 2.2 ( P < .001), 2.4 ± 1.8 ( P < .001), and 2.57 ± 2.9 ( P < .001), respectively. Mean ± SD rearfoot scores in the same groups improved from 64.1 ± 15.1, 71.6 ± 1, and 65.7 ± 12.7 to 78.2 ± 12.4 ( P = .018), 80.9 ± 13.9 ( P = .025), and 80.07 ± 17.5 ( P = .030), respectively. There were no statistically significant differences among the groups. Good outcomes have been documented using the peppering technique and autologous blood injection for the treatment of lateral epicondylitis. Although the curative mechanisms of both injection modalities are based on a hypothesis, they seem to be good alternatives to corticosteroid injection for the treatment of plantar heel pain. (J Am Podiatr Med Assoc 96(4): 293–296, 2006)

To assess tibialis posterior tendon (TPT) pathology, we investigated 27 feet with the accessory navicular bone and 22 normal feet by MRI. We found two major anatomical differences in the feet with the accessory navicular bone; the TPT directly inserted in the accessory navicular bone, without any continuity to the sole of the foot or with a slip, less than 1 mm in thickness, and there was a mass with the density of fibrocartilage tissue, between the tendon and the bone in 20/ 27 feet. These abnormalities were not detected in the control group. 3 patients in the study group were operated on and the MRI findings were confirmed. These findings suggest that patients with the accessory navicular bone and flatfoot should be examined by MRI for insertion abnormalities of the TPT.