Arthroscopic Chondral Defect Repair With Extracellular Matrix Scaffold and Bone Marrow Aspirate Concentrate

Abstract

Chondral defects of the knee are prevalent and often encountered during arthroscopic procedures. Despite the limited healing potential of chondral defects, several treatment options have been proposed. However, microfracture, osteochondral autograft (or allograft) transfer, autologous chondrocyte implantation, and matrix-induced autologous chondrocyte implantation are all associated with their respective shortcomings. As such, the optimal treatment for chondral defects of the knee remains unclear. Recently, many authors have advocated treating chondral defects with biological therapies and scaffold-based treatments. Bone marrow aspirate concentrate, a cell-based injection, has gained particular attention because of its differentiation capacity and potential role in tissue regeneration. In addition, scaffold cartilage treatments have emerged and reached clinical practice. BioCartilage is one form of scaffold, which consists of extracellular matrix, and has been claimed to promote the regeneration of hyaline-like cartilage. This article presents our technique of arthroscopic chondral defect repair using BMAC and BioCartilage.

Autologous Matrix Induced Chondrogenesis (AMIC) Compared to Microfractures for Chondral Defects of the Talar Shoulder: A Five-Year Follow-Up Prospective Cohort Study

“…Symptomatic chondral defects negatively affect the activities of daily life and sporting activity level [ 25 , 31 ]. The low metabolic activity of hyaline cartilage, along with its alymphatic and hypocellular structure, are some of the reasons behind its poor regenerative capabilities [ 3 , 4 , 5 ]. Cartilage healing typically does not restore the original tissue, and fibrosis and residual chondral defects are common [ 32 , 33 ].…”

“…Both these studies were performed in a cohort of patients with small defects. Indeed, for small defects, MFx is still the most appropriate procedure [ 3 , 4 , 5 , 9 ]. Furthermore, the relatively short length of the follow-up may also affect the results.…”

“…Focal chondral defects of the talar shoulder are common [ 1 , 2 ]. Given the limited self-healing capability of cartilage, chondral defects are debilitating, often requiring surgical management [ 3 , 4 , 5 ]. Isolated microfractures (MFx) are recommended for defects smaller than 2.5 cm 2 [ 6 , 7 , 8 , 9 , 10 ].…”

Capsular Management of the Hip During Arthroscopic Acetabular Chondral Resurfacing: Pearls, Pitfalls, and Optimal Surgical Technique

“…Recent reports have chosen to use readily available synthetic products such as BioCartilage (Arthrex, Naples, FL) as a viable alternative. [19][20][21][22][23][24][25][26] BioCartilage is a synthetic cartilage graft that supplies the much-needed matrix substances such as proteoglycans, type II collagen, and relevant growth factors. 27 This synthetic scaffold, when mixed with autologous blood solutions such as bone marrow aspirate concentrate (BMAC) or conditioned leukocyte-reduced platelet-rich plasma, is known to enhance chondrogenesis in the microfracture defect bed, resembling articular cartilage.…”

“…27 This synthetic scaffold, when mixed with autologous blood solutions such as bone marrow aspirate concentrate (BMAC) or conditioned leukocyte-reduced platelet-rich plasma, is known to enhance chondrogenesis in the microfracture defect bed, resembling articular cartilage. [19][20][21][22][23][24][25][26] However, the optimal technique and protocol for construct adherence and clot stability are yet to be established. 28 None of these published reports on hip arthroscopic cartilage resurfacing have mentioned any details of capsular management as part of the procedure.…”