Combined Bone Marrow Aspirate and Platelet-Rich Plasma for Cartilage Repair: Two-Year Clinical Results

Cartilage ◽  
2019 ◽  
pp. 194760351987632 ◽  
Author(s):  
Kris Hede ◽  
Bjørn B. Christensen ◽  
Jonas Jensen ◽  
Casper B. Foldager ◽  
Martin Lind
Keyword(s):  
Bone Marrow ◽  
Magnetic Resonance ◽  
Clinical Outcome ◽  
Cartilage Repair ◽  
Bone Marrow Aspirate ◽  
Platelet Rich Plasma ◽  
Collagen Scaffold ◽  
Repair Tissue ◽  
Outcome Scores

Purpose To evaluate the clinical and biological outcome of combined bone marrow aspirate concentrate (BMAC) and platelet-rich plasma (PRP) on a collagen scaffold for treating cartilage lesions in the knee. Methods and Materials Ten patients (mean age 29.4 years, range 18-36) suffering from large full-thickness cartilage in the knee were treated with BMAC and PRP from January 2015 to December 2016. In a 1-step procedure autologous BMAC and PRP was seeded onto a collagen scaffold and sutured into the debrided defect. Patients were evaluated by clinical outcome scores (IKDC [International Knee Documentation Committee Subjective Knee Form], KOOS [Knee Injury and Osteoarthritis Outcome Score], and pain score using the Numeric Rating Scale [NRS]) preoperatively, after 3 months, and after 1 and 2 years. Second-look arthroscopies were performed ( n = 7) with biopsies of the repair tissue for histology. All patients had magnetic resonance imaging (MRI) preoperatively, after 1 year, and after 2 to 3.5 years with MOCART (magnetic resonance observation of cartilage repair tissue) scores evaluating cartilage repair. Results After 1 year significant improvements were found in IKDC, KOOS symptoms, KOOS ADL (Activities of Daily Living), KOOS QOL (Quality of Life), and pain at activity. At the latest follow-up significant improvements were seen in IKDC, KOOS symptoms, KOOS QOL, pain at rest, and pain at activity. MRI MOCART score for cartilage repair improved significantly from baseline to 1-year follow-up. Histomorphometry of repair tissue demonstrated a mixture of fibrous tissue (58%) and fibrocartilage (40%). Conclusion Treatment of cartilage injuries using combined BMAC and PRP improved subjective clinical outcome scores and pain scores at 1 and 2 years postoperatively. MRI and histology indicated repair tissue inferior to the native hyaline cartilage.

scholarly journals Comparison of Bone Marrow Aspirate Concentrate and Allogenic Human Umbilical Cord Blood Derived Mesenchymal Stem Cell Implantation on Chondral Defect of Knee: Assessment of Clinical and Magnetic Resonance Imaging Outcomes at 2-Year Follow-Up

2020 ◽  
Vol 29 ◽  
pp. 096368972094358
Author(s):  
Dong Jin Ryu ◽  
Yoon Sang Jeon ◽  
Jun Sung Park ◽  
Gi Cheol Bae ◽  
Jeong-seok Kim ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Stem Cells ◽  
Bone Marrow ◽  
Magnetic Resonance ◽  
Cartilage Repair ◽  
Bone Marrow Aspirate ◽  
Human Umbilical Cord Blood ◽  
Human Umbilical Cord ◽  
Resonance Imaging

Biological repair of cartilage lesions remains a significant clinical challenge. A wide variety of methods involving mesenchymal stem cells (MSCs) have been introduced. Because of the limitation of the results, most of the treatment methods have not yet been approved by the Food and Drug Administration (FDA). However, bone marrow aspirate concentrate (BMAC) and human umbilical cord blood derived mesenchymal stem cells (hUCB-MSCs) implantation were approved by Korea FDA. The aim of this study was to evaluate clinical and magnetic resonance imaging (MRI) outcomes after two different types of MSCs implantation in knee osteoarthritis. Fifty-two patients (52 knees) who underwent cartilage repair surgery using the BMAC (25 knees) and hUCB-MSCs (27 knees) were retrospectively evaluated for 2 years after surgery. Clinical outcomes were evaluated according to the score of visual analogue scale (VAS), the International Knee Documentation Committee (IKDC) subjective, and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Cartilage repair was assessed according to the modified Magnetic Resonance Observation of Cartilage Repair Tissue (M-MOCART) score and the International Cartilage Repair Society (ICRS) cartilage repair scoring system. At 2-year follow-up, clinical outcomes including VAS, IKDC, and KOOS significantly improved ( P < 0.05) in both groups; however, there were no differences between two groups. There was no significant difference in M-MOCART [1-year ( P = 0.261), 2-year ( P = 0.351)] and ICRS repair score ( P = 0.655) between two groups. Both groups showed satisfactory clinical and MRI outcomes. Implantation of MSCs from BMAC or hUCB-MSCs is safe and effective for repairing cartilage lesion. However, large cases and a well-controlled prospective design with long-term follow-up studies are needed.

scholarly journals A 5-Year Follow-Up After Cartilage Repair in the Knee Using a Platelet-Rich Plasma-Immersed Polymer-Based Implant

2014 ◽  
Vol 8 (1) ◽  
pp. 346-354 ◽  
Author(s):  
Alberto Siclari ◽  
Gennaro Mascaro ◽  
Christian Kaps ◽  
Eugenio Boux
Keyword(s):  
Clinical Outcome ◽  
Cartilage Repair ◽  
Platelet Rich Plasma ◽  
Polyglycolic Acid ◽  
Cartilage Defects ◽  
Bone Marrow Stimulation ◽  
Chondral Defects ◽  
Autologous Platelet Rich Plasma ◽  
Autologous Platelet

The aim of our study was to analyze the clinical outcome after repair of cartilage defects of the knee with subchondral drilling and resorbable polymer-based implants immersed with autologous platelet-rich plasma (PRP). Fifty-two patients with focal chondral defects were treated with subchondral drilling, followed by covering with a polyglycolic acid - hyaluronan (PGA-HA) implant (chondrotissue®) immersed with autologous PRP. At 5-year follow-up, patients’ situation was assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and compared to the pre-operative situation. The KOOS showed clinically meaningful and significant (p < 0.05) improvement in all subcategories compared to baseline. Subgroup analysis showed that there were no differences in the clinical outcome regarding defect size and localization as well as degenerative condition of the knee. Cartilage repair was complete in 20 out of 21 patients at 4-year follow-up as shown by magnetic resonance observation of cartilage repair tissue (MOCART) scoring. Covering of focal cartilage defects with the PGA-HA implant and PRP after bone marrow stimulation leads to a lasting improvement of the patients’ situation.

One-Step Treatment for Patellar Cartilage Defects With a Cell-Free Osteochondral Scaffold: A Prospective Clinical and MRI Evaluation

2017 ◽  
Vol 45 (7) ◽  
pp. 1581-1588 ◽  
Author(s):  
Francesco Perdisa ◽  
Giuseppe Filardo ◽  
Andrea Sessa ◽  
Maurizio Busacca ◽  
Stefano Zaffagnini ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Clinical Outcome ◽  
Cartilage Defects ◽  
Osteochondral Lesions ◽  
Repair Tissue ◽  
Osteochondral Scaffold ◽  
Patellar Cartilage ◽  
A Cell ◽  
Mri Evaluation

Background: The treatment of symptomatic cartilage defects of the patella is particularly challenging, and no gold standard is currently available. Purpose: To evaluate the clinical results of a biphasic cell-free collagen-hydroxyapatite scaffold and to evaluate osteochondral tissue regeneration with magnetic resonance imaging (MRI). Study Design: Case series; Level of evidence, 4. Methods: Thirty-four patients (18 men and 16 women; mean ± SD: age, 30.0 ± 10 years) were treated by scaffold implantation for knee chondral or osteochondral lesions of the patella (area, 2.1 ± 1 cm2). The clinical evaluation was performed prospectively at 12 and 24 months via the IKDC (International Knee Documentation Committee; objective and subjective) and Tegner scores. MRI evaluation was performed at both follow-ups in 18 lesions through the MOCART score (magnetic resonance observation of cartilage repair tissue) and specific subchondral bone parameters. Results: A statistically significant improvement in all the scores was observed at 12- and 24-month follow-up as compared with the basal evaluation. The IKDC subjective score improved from 39.5 ± 14.5 to 61.9 ± 14.5 at 12 months ( P > .0005) with a further increase to 67.6 ± 17.4 at 24 months of follow-up (12-24 months, P = .020). The MRI evaluation showed a stable value of the MOCART score between 12 and 24 months, with a complete filling of the cartilage in 87.0% of the lesions, complete integration of the graft in 95.7%, and intact repair tissue surface in 69.6% at final follow-up. The presence of osteophytes or more extensive bony overgrowth was documented in 47.8% of the patients of this series, but no correlation was found between MRI findings and clinical outcome. Conclusion: The implantation of a cell-free collagen-hydroxyapatite osteochondral scaffold provided a clinical improvement at short-term follow-up for the treatment of patellar cartilage defects. Women had lower outcomes, and the need for realignment procedures led to a slower recovery. MRI evaluation showed some abnormal findings with the presence of bone overgrowth, but no correlation has been found with the clinical outcome.

scholarly journals Patient-Reported Outcomes After Platelet-Rich Plasma, Bone Marrow Aspirate, and Adipose-Derived Mesenchymal Stem Cell Injections for Symptomatic Knee Osteoarthritis

2020 ◽  
Vol 13 ◽  
pp. 117954412093108
Author(s):  
Esteban Estrada ◽  
Jose L Décima ◽  
Marcelo Rodríguez ◽  
Marianela Di Tomaso ◽  
Javier Roberti
Keyword(s):  
Bone Marrow ◽  
Stem Cell ◽  
Mesenchymal Stem Cell ◽  
Bone Marrow Aspirate ◽  
Platelet Rich Plasma ◽  
Functional Score ◽  
Treatment Groups ◽  
Symptomatic Knee Osteoarthritis ◽  
Symptomatic Knee

Objective: The objective of this study was to compare platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC), and adipose-derived mesenchymal stem cell (MSC) injections in the treatment of osteoarthritis (OA) of the knee using functional scores. Methods: A total of 89 patients with painful knee OA were included in this study. Patients were assigned to one of the 3 treatments according to severity of OA as indicated by symptoms and radiography to PRP (stage I), BMAC (stage II), or adipose-derived MSC (stage III). Clinical assessment was performed using the Knee Society Score, which combines the Knee Score, based on the clinical parameters, and the Functional Score, and IKDC score. Surveys were completed at preoperative and at 90, 180, and 265 days postoperative. The follow-up responses were compared with baseline and between treatment groups. Results: Treatment with PRP, BMAC, and adipose-derived MSC included 29 (32.6%), 27 (30.3%), and 33 (37.1%) patients, respectively. For the total group, median age was 61 years (range: 22-84 years). Score values were comparable among treatment groups at baseline. Statistically significant improvement was observed in the 3 groups according to the 3 scores at all time points during follow-up compared with baseline. No difference was found among treatment type. Conclusions: Our findings support previous reports and encourage further research on the use of these cost-effective treatments for OA of the knee.

scholarly journals Surgical Fixation of Chondral-Only Fragments of the Knee: A Case Series With a Mean 4-Year Follow-up

2021 ◽  
Vol 9 (1) ◽  
pp. 232596712096139
Author(s):  
Andrew Gudeman ◽  
Dillen Wischmeier ◽  
Jack Farr
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Clinical Outcome ◽  
Arthroscopic Surgery ◽  
Case Series ◽  
Resonance Imaging ◽  
Outcome Scores ◽  
Surgical Fixation ◽  
The Mean

Background: Chondral-only fragments of the knee have traditionally been treated with excision, with or without cartilage restoration procedures. This is because of the historical assumption that cartilage has limited ability to heal to cancellous or subchondral bone. There is now a growing body of evidence supporting surgical fixation of these fragments. Hypothesis: We hypothesized that surgical fixation of chondral fragments would result in acceptable rates of healing with improvement in clinical outcome scores. Study Design: Case series; Level of evidence, 4. Methods: Data were collected on 15 surgically fixed chondral-only fragments in 14 patients. We retrospectively collected participant demographic information, lesion characteristics, primary mechanism (osteochondritis dissecans vs traumatic shear injury), fixation methods, reoperation information, second-look arthroscopic information, and clinical outcome scores. The mean clinical follow-up was 3.96 years, with a minimum of 1-year follow-up. All patients underwent follow-up magnetic resonance imaging at a mean of 2 years after the index procedure. Results: The mean age of our cohort was 17.7 years. We found an 80% survival rate for fixation of the fragments at a mean 4-year follow-up. There were statistically significant improvements in postoperative Knee injury and Osteoarthritis Outcome Score and Tegner scores compared with preoperative scores. Follow-up magnetic resonance imaging scans showed complete healing in 10 knees, partial healing in 2 knees, and loss of fixation in 3 knees. Second-look arthroscopic surgery of 3 knees for reasons other than fragment symptoms showed healing of the fragment, while arthroscopic surgery of 3 symptomatic knees showed loss of fixation. Conclusion: Surgical fixation of chondral-only lesions showed an 80% success rate with improvements in the KOOS and Tegner scores.

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