scholarly journals Combination of Filtered Bone Marrow Aspirate and Biomimetic Scaffold for the Treatment of Knee Osteochondral Lesions: Cellular and Early Clinical Results of a Single Centre Case Series

2020 ◽  
Vol 17 (3) ◽  
pp. 375-386 ◽  
Author(s):  
Matija Veber ◽  
Jan Vogler ◽  
Miomir Knežević ◽  
Ariana Barlič ◽  
Matej Drobnič
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Aspirate ◽  
Case Series ◽  
Clinical Results ◽  
Osteochondral Lesions ◽  
Single Centre ◽  
Biomimetic Scaffold

scholarly journals Return to Sports After Bone Marrow–Derived Cell Transplantation for Osteochondral Lesions of the Talus

Cartilage ◽  
2016 ◽  
Vol 8 (1) ◽  
pp. 80-87 ◽  
Author(s):  
Francesca Vannini ◽  
Marco Cavallo ◽  
Laura Ramponi ◽  
Francesco Castagnini ◽  
Simone Massimi ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Cell Transplantation ◽  
Case Series ◽  
Clinical Results ◽  
Osteochondral Lesions ◽  
Return To Sports ◽  
One Step ◽  
American Orthopaedic ◽  
Return To Activity

Objective Arthroscopic “one-step” technique based on bone marrow–derived cell transplantation (BMDCT) have achieved good results in repairing osteochondral lesions of the talus (OLT), overcoming important drawbacks of older techniques. It may be particularly adequate for the treatment of athletes in order to permit a safe and stable return to sports. The aim of this study was to report the results at 48 months of a series of athletes and the factors influencing the return to sports. Design Case series. A total of 140 athletes underwent a “one-step” BMDCT repair of OLT. All the patients had the cells harvested from the iliac crest, condensed and loaded on a scaffold, and then implanted. Patients were evaluated clinically by the American Orthopaedic Foot and Ankle Society (AOFAS) scores and Halasi score. Results AOFAS score improved from 58.7 ± 13.5 preoperatively to 90.6 ± 8.6 ( P < 0.005) at 24 months, and to 90.9 ± 10.7 at 48 months. Halasi score was 6.88 ± 1.8 preinjury, 4.08 ± 1.7 preoperatively, and 5.56 ± 2.0 at final follow-up. At the final follow-up, all the patients (beside 1 failure and 3 lost) were able to return to activity and 72.8% were able to resume sports at preinjury level. Conclusions “One-step” BMDCT repair of OLT had good clinical results that was durable over time in athletes, permitting a return to sports at preinjury level in the majority of patients. The preoperative presence of impingement and articular degeneration were the main negative prognostic factors.

scholarly journals Outcomes of Surgical Treatment of Talar Osteochondral Lesions using Bone Marrow Aspirate and Microgenized Allograft Cartilage Extra-cellular Matrix

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0021
Author(s):  
Robert Dekker ◽  
Milap Patel
Keyword(s):  
Bone Marrow ◽  
Surgical Treatment ◽  
Functional Outcomes ◽  
Bone Marrow Aspirate ◽  
Case Series ◽  
Cartilage Matrix ◽  
Osteochondral Lesions ◽  
Measurement Information ◽  
Significant Difference ◽  
Patient Reported

Category: Sports Introduction/Purpose: Osteochondral lesions (OCL) of the talus are frequently seen after ankle injury and often result in significant morbidity. Apart from a single case report, we are the first to present a case series of OCLs treated with bone marrow aspirate and micronized extracellular allograft cartilage matrix designed to serve as a scaffold to promote autologous healing. Short to mid-term outcomes using this technique are virtually absent in the literature. In this study, we sought to assess pre- and post-procedural functional outcomes using the validated Patient Reported Outcomes Measurement Information System (PROMIS) as well as assess cartilage incorporation on postoperative ankle MRI using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scoring. Methods: Twelve patients with symptomatic talar OCLs (14 lesions) were prospectively recruited. Average age was 44 years. Each underwent ankle arthroscopy, ankle arthrotomy, marrow stimulation and lesion repair using BMA and micronized extracellular allograft cartilage matrix by a single fellowship trained foot and ankle Orthopedic Surgeon. Preoperative, 6 month and 1 year postoperative PROMIS pain and function scores were collected prospectively. At six months, all patients underwent ankle MRI scans that were reviewed by a fellowship trained musculoskeletal radiologist for MOCART scoring. Results: No significant difference was detected between mean pre- and postoperative PROMIS function (41.4 vs 38.1; p=.54) and pain (61.3 vs 66.1) scores at 6 months. No significant difference was seen between mean pre- and postoperative PROMIS function (41.4 vs 41.8; p=.93) and pain (61.3 vs 58; p=.48) scores at 1 year. Mean postoperative MOCART score was 53.2 with a range of 5 to 90. Conclusion: Bone marrow aspirate and extracellular allograft cartilage matrix for surgical treatment of talar OCL showed no statistically significant improvement in functional outcomes at 6 months and 1 year. No correlation between functional outcomes and MOCART score was seen.

scholarly journals One-step bone marrow-derived cell transplantation in talarosteochondral lesions: mid-term results

Joints ◽  
2013 ◽  
Vol 01 (03) ◽  
pp. 102-107 ◽  
Author(s):  
Roberto Buda ◽  
Francesca Vannini ◽  
Marco Cavallo ◽  
Matteo Baldassarri ◽  
Simone Natali ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Scale Score ◽  
Case Series ◽  
Clinical Results ◽  
Osteochondral Lesions ◽  
Prospective Clinical Study ◽  
One Step ◽  
Bone Marrow Derived Cells ◽  
The Mean

Purpose: to verify the capability of scaffold-supported bone marrow-derived cells to be used in the repair of osteochondral lesions of the talus. Methods: using a device to concentrate bone marrow-derived cells, a scaffold (collagen powder or hyaluronic acid membrane) for cell support and platelet gel, a one-step arthroscopic technique was developed for cartilage repair. In a prospective clinical study, we investigated the ability of this technique to repair talar osteochondral lesions in 64 patients. The mean follow-up was 53 months. Clinical results were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) scale score. We also considered the influence of scaffold type, lesion area, previous surgery, and lesion depth. Results: the mean preoperative AOFAS scale score was 65.2 ± 13.9. The clinical results peaked at 24 months, before declining gradually to settle at a score of around 80 at the maximum follow-up of 72 months. Conclusions: the use of bone marrow-derived cells supported by scaffolds to repair osteochondral lesions of the talus resulted in significant clinical improvement, which was maintained over time. Level of Evidence: level IV, therapeutic case series.

scholarly journals Phases 1–3 Clinical Trials Using Adult Stem Cells in Osteonecrosis and Nonunion Fractures

2010 ◽  
Vol 2010 ◽  
pp. 1-4 ◽  
Author(s):  
Jean-Philippe Hauzeur ◽  
Valérie Gangji
Keyword(s):  
Stem Cells ◽  
Bone Marrow ◽  
Adult Stem Cells ◽  
Bone Marrow Aspirate ◽  
Direct Injection ◽  
Case Series ◽  
Autologous Bone Marrow ◽  
Bone Necrosis ◽  
Concentrated Bone Marrow ◽  
Made In

Nonunion fractures and aseptic bone necrosis are two pathological conditions having some impairment of the cellular part of the repair: a reduction of MSC and of the osteoblastic activation. Both are good candidates for cell-based therapies using stem cells. We made a review of the published human trials. Only autologous bone marrow aspirate implantation was until now used. In Nonunion, a direct injection—15 to 150 ml—was made in 4 case series studies. In another, the bone marrow aspirate was concentrated before injection. The results were good. In bone necrosis, only one level 1 study was published. The results at 24 months were positive in terms of reduction of the necrosis and appearance of collapse. In 3 case series studies, a treatment with concentrated bone marrow aspirates was deemed useful with good results in 76 to 96%. These results are interesting but need confirmation by controlled studies.

scholarly journals Autologous Stem Cells in Cervical Spine Fusion

2020 ◽  
pp. 219256822094847
Author(s):  
Patrick C. Hsieh ◽  
Andrew S. Chung ◽  
Darrel Brodke ◽  
Jong-Beom Park ◽  
Andrea C. Skelly ◽  
...  
Keyword(s):  
Stem Cells ◽  
Bone Marrow ◽  
Cervical Spine ◽  
Bone Marrow Aspirate ◽  
A Priori ◽  
Case Series ◽  
Fusion Rate ◽  
Spine Fusion ◽  
Retrospective Cohort Studies ◽  
Cervical Spine Fusion

Study Design: Systematic review. Objectives: To systematically review, critically appraise and synthesize evidence on use of stem cells from autologous stem cells from bone marrow aspirate, adipose, or any other autologous sources for fusion in the cervical spine compared with other graft materials. Methods: A systematic search of PubMed/MEDLINE was conducted for literature published through October 31, 2018 and through February 20, 2020 for EMBASE and ClinicalTrials.gov comparing autologous cell sources for cervical spine fusion to other graft options. Results: From 36 potentially relevant citations identified, 10 studies on cervical fusion met the inclusion criteria set a priori. Two retrospective cohort studies, one comparing cancellous bone marrow (CBM) versus hydroxyapatite (HA) and the other bone marrow aspirate (BMA) combined with autograft and HA versus autograft and HA alone, were identified. No statistical differences were seen between groups in either study for improvement in function, symptoms, or fusion; however, in the study evaluating BMA, the authors reported a statistically greater fusion rate and probability of fusion over time in the BMA versus the non-BMA group. Across case series evaluating BMA, authors reported improved function and pain and fusion ranged from 84% to 100% across the studies. In general, complications were poorly reported. Conclusions: The overall quality (strength) of evidence of effectiveness and safety of autologous BMA for cervical arthrodesis in the current available literature was very low. Based on currently available data, firm conclusions regarding the effectiveness or safety of BMA in cervical fusions cannot be made.

scholarly journals Outcomes Following Treatment of Talar Osteochondral Lesions with a Mixture of Particulate Allogenic Cartilage Extracellular Matrix and Bone Marrow Aspirate Concentrate: A Case Control Series

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0032
Author(s):  
Mark C. Drakos ◽  
Taylor Nicole Cabe ◽  
Carolyn Sofka ◽  
Peter D. Fabricant ◽  
Jonathan T. Deland
Keyword(s):  
Bone Marrow ◽  
Extracellular Matrix ◽  
Bone Marrow Aspirate ◽  
Case Control ◽  
Osteochondral Lesions ◽  
Treatment Groups ◽  
Cartilage Extracellular Matrix

Objectives: There continues to be a general lack of consensus regarding the optimal treatment for osteochondral lesions of the talus (OLTs). Microfracture, once considered the gold-standard, has been associated with poor long-term results due to the formation of biomechanically inferior reparative fibrocartilage as opposed to hyaline cartilage. Particulate allogenic cartilage extracellular matrix offers a promising solution as an adjuvant therapy; however, there is currently minimal objective evidence to indicate its effect on post-operative outcomes. This study compares post-operative radiographic and clinical outcomes following treatment of OLTs with an adjuvant mixture of particulate cartilage extracellular matrix and bone marrow aspirate concentrate (BMAC) against outcomes following microfracture with or without BMAC. Methods: Patients diagnosed with an OLT and treated by a fellowship-trained orthopedic surgeon were screened for inclusion. Those whose surgical intervention included microfracture, microfracture augmented with BMAC alone, or microfracture augmented with a mixture of BMAC and particulate allogenic cartilage extracellular matrix were eligible for this case-control study. Lesion size, location, and concurrent injuries were recorded following retrospective chart review. Foot and Ankle Outcome Scores (FAOS) were collected pre-operatively and at a minimum of 1 year post-operatively through the prospective Registry database at the authors’ institution. Modified magnetic resonance observation of cartilage repair tissue (MOCART) scoring evaluated the structural quality of repaired lesions on MRIs collected greater than six months post-operatively. Differences in post-operative MOCART and FAOS scores were evaluated using ANOVA tests. Results: Forty-seven patients treated with microfracture alone, forty-seven treated with microfracture augmented by BMAC, and fifty-two treated with an adjuvant mixture of particulate allogenic cartilage extracellular matrix and BMAC were identified at a minimum of 2 years post-operatively. Average MOCART scores were significantly different between treatment groups (p=0.03). At an average follow-up of 10.86 months, patients who received adjunctive therapy had an average MOCART score of 73.5 ± 11.13. At an average follow-up of 23.06 months and 43.6 months respectively, patients treated with microfracture and BMAC and microfracture alone scored 63.33 ± 22.23 and 55 ± 23.92. There was no detectable statistically significant difference in post-operative FAOS scores between treatment groups. With respect to revision surgery, two patients (3.84%) originally treated with adjuvant particulate cartilage extracellular matrix and BMAC have required a secondary surgery as opposed to nine patients (9.57%) treated with microfracture and BMAC or microfracture alone. Conclusion: Increases in post-operative FAOS scores compared to pre-operative FAOS scores for all treatment groups indicate patients’ function and symptoms improved regardless of intervention received. However, significantly higher MOCART scores for the particulate cartilage extracellular matrix and BMAC treatment group suggest adjuvant treatment may help achieve better post-operative fill and structural integrity. Thus, long-term outcomes and the quality of reparative tissues may be improved through use of adjuvant treatments such as particulate allogenic cartilage extracellular matrix and BMAC.

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