scholarly journals Autograft Cartilage Transfer Augmented With Bone Marrow Concentrate and Allograft Cartilage Extracellular Matrix

2020 ◽  
Vol 9 (2) ◽  
pp. e199-e203
Author(s):  
Chad Lavender ◽  
Syed Ali Sina Adil ◽  
Vishavpreet Singh ◽  
Galen Berdis
Keyword(s):  
Bone Marrow ◽  
Extracellular Matrix ◽  
Bone Marrow Concentrate ◽  
Cartilage Extracellular Matrix

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.

The effect of cartilage extracellular matrix particle size on the chondrogenic differentiation of bone marrow mesenchymal stem cells

2019 ◽  
Vol 14 (7) ◽  
pp. 663-680 ◽  
Author(s):  
Chenjun Zhai ◽  
Xiao Zhang ◽  
Jun Chen ◽  
Jian He ◽  
Hao Fei ◽  
...  
Keyword(s):  
Stem Cells ◽  
Bone Marrow ◽  
Extracellular Matrix ◽  
Particle Size ◽  
Mesenchymal Stem Cells ◽  
Small Particle ◽  
Large Particle ◽  
Chondrogenic Differentiation ◽  
Glycolic Acid ◽  
Cartilage Extracellular Matrix

Aim: To investigate the effect of cartilage extracellular matrix (ECM) particle size on the chondrogenic differentiation of bone marrow-derived mesenchymal stem cells (BMSCs). Materials & methods: BMSCs were seeded into the scaffolds fabricated by small particle ECM materials and large particle ECM materials. For the positive control, chondrogenically induced BMSCs were seeded into commercial poly-lactic-glycolic acid scaffolds. Macroscopic observation, histological and immunohistochemical staining, mechanical testing and biochemical analysis were performed to the cell-scaffold constructs. Results: BMSCs in small particle ECM materials and poly-lactic-glycolic acid scaffolds were induced to differentiate into chondrocytes, while BMSCs in the large particle ECM materials scaffold did not differentiate into chondrocytes. Conclusion: The small ECM particle materials improved the induction ability of the cartilage ECM-derived scaffold.

scholarly journals Treatment of Large Osteochondral Lesions with Adjuvant Micronized Allogenic Cartilage Extracellular Matrix and Bone Marrow Aspirate Concentrate Reduces Rate of Postoperative Adjacent Cysts

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0016
Author(s):  
Mark C. Drakos ◽  
Taylor N. Cabe ◽  
Carolyn Sofka ◽  
John Kennedy ◽  
Jonathan Deland
Keyword(s):  
Bone Marrow ◽  
Extracellular Matrix ◽  
Adjuvant Therapy ◽  
Bone Marrow Aspirate ◽  
Therapy Group ◽  
Osteochondral Lesions ◽  
Foot And Ankle ◽  
Cartilage Extracellular Matrix ◽  
Outcome Scores

Category: Ankle, Arthroscopy, Sports Introduction/Purpose: Previous studies have established a correlation between the size of osteochondral lesions (OCLs) and the relative success of outcomes following surgical repair. Poorer results have been associated with traditional microfracture for lesions larger than 150 mm2. In these cases, osteochondral autograft transplantation (OAT) has shown to be a generally effective treatment despite associated disadvantages that include donor site morbidity, need to perform an osteotomy, and formation of postoperative adjacent cysts. The purpose of this study was to assess the effect of using a micronized allogenic cartilage extracellular matrix (ECM) mixed with bone marrow aspirate concentrate (BMAC) as an adjuvant therapy to augment and potentially improve the quality of repair achieved using OAT to treat larger lesions. Methods: Seventy cases (average age 38) treated by a fellowship-trained foot and ankle surgeon for an osteochondral lesion using OAT between December 2009 and June 2018 were identified. Retrospective chart review determined that 40 patients received adjuvant micronized ECM mixed with BMAC (average follow-up 25.6 months) while 30 had only BMAC injected into the joint or lesion (average follow-up 81.9 months). Preoperative lesion size, lesion location, and any concurrent injuries were also recorded. Foot and Ankle Outcome Scores (FAOS) were completed pre- and postoperatively through the prospective registry database at the authors’ institution. Structural integrity of reparative cartilage was assessed on available postoperative MRIs using a modified magnetic resonance observation of cartilage repair tissue (MOCART) score. In addition, the presence of postoperative edema and adjacent cystic changes were recorded. Linear regression analysis was performed to analyze differences in MOCART scores, FAOS, postoperative rate of adjacent cysts, and postoperative rate of edema. Results: Twenty-four postoperative MRIs, average follow-up 14.04 (SD 9.52) months, were available for the ECM+BMAC adjuvant therapy group. Twenty-one MRIs, average follow-up 35.06 months (SD 28.41), were available for the non-adjuvant therapy group. 20.8% of the ECM+BMAC group exhibited signs of postoperative cysts compared to 60.9% of patients in the non- adjuvant therapy OAT group (p<0.01). Similarly, 66.7% of ECM+BMAC patients had edema postoperatively versus 90.5% of patients in the non-adjuvant therapy cohort (p = 0.05). MOCART scores were similar in each group: 68.33 (SD=15.99) in the OAT and ECM+BMAC group and 65.95 (SD=22.50) in the non-adjuvant therapy group. Finally, the post-operative FAOS Symptoms scores were significantly greater in patients receiving adjuvant therapy (p=0.03). Conclusion: Using micronized allogenic cartilage ECM mixed with BMAC to augment traditional OAT helps reduce the rate of postoperative adjacent cysts and edema. In addition, greater increases in patient reported functional outcome scores indicate this adjuvant therapy may help improve clinical outcomes. Application of this adjuvant therapy could be especially useful in allowing easier treatment of non-circular lesions of amorphous shapes. By improving integration of OAT into surrounding bone and reducing the rate of postoperative cysts, adjuvant therapy may improve long-term outcomes for large OCLs.

scholarly journals Effect of Oral Losartan on Orthobiologics: Implications for Platelet-Rich Plasma and Bone Marrow Concentrate—A Rabbit Study

2020 ◽  
Vol 21 (19) ◽  
pp. 7374
Author(s):  
Gilberto Y. Nakama ◽  
Sabrina Gonzalez ◽  
Polina Matre ◽  
Xiaodong Mu ◽  
Kaitlyn E. Whitney ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Osteochondral Defect ◽  
Platelet Rich Plasma ◽  
Control Group ◽  
Bone Marrow Concentrate ◽  
Significant Difference ◽  
Losartan Group ◽  
Group 2 ◽  
And Control ◽  
Tgf Β1

Recent efforts have focused on customizing orthobiologics, such as platelet-rich plasma (PRP) and bone marrow concentrate (BMC), to improve tissue repair. We hypothesized that oral losartan (a TGF-β1 blocker with anti-fibrotic properties) could decrease TGF-β1 levels in leukocyte-poor PRP (LP-PRP) and fibrocytes in BMC. Ten rabbits were randomized into two groups (N = 5/group): osteochondral defect + microfracture (control, group 1) and osteochondral defect + microfracture + losartan (losartan, group 2). For group 2, a dose of 10mg/kg/day of losartan was administrated orally for 12 weeks post-operatively. After 12 weeks, whole blood (WB) and bone marrow aspirate (BMA) samples were collected to process LP-PRP and BMC. TGF-β1 concentrations were measured in WB and LP-PRP with multiplex immunoassay. BMC cell populations were analyzed by flow cytometry with CD31, CD44, CD45, CD34, CD146 and CD90 antibodies. There was no significant difference in TGF-β1 levels between the losartan and control group in WB or LP-PRP. In BMC, the percentage of CD31+ cells (endothelial cells) in the losartan group was significantly higher than the control group (p = 0.008), while the percentage of CD45+ cells (hematopoietic cells-fibrocytes) in the losartan group was significantly lower than the control group (p = 0.03).

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