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

Abstract

The use of biologics in sports medicine is increasing rapidly. An osteochondral defect in a young active patient remains a difficult issue to treat. Autograft cartilage has tremendous advantages for the treatment of full-thickness defects, but harvesting and preparation have been difficult in the past. Disadvantages have included donor-site morbidity and the need for further surgery. With the recent development of the GraftNet device (Arthrex, Naples, FL), harvesting and delivery of autograft have become easier and can be performed arthroscopically in a single surgical procedure. Bone marrow concentrate has recently increased in popularity owing to the presence of mesenchymal stem cells. These stem cells combined with autograft cartilage and BioCartilage (Arthrex) could lead to better incorporation and healing. In this article, we show how this unique biological composite is obtained and then added in the cartilage defect during a singlestage arthroscopic procedure.

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

“…Recently, multiple short-term outcome studies have been published quoting superior results when microfracture is augmented with synthetic matrix substances (BioCartilage in particular) resulting in hyaline-like cartilage repair in the knee, ankle (talus), and shoulder. [19][20][21][23][24][25] Recently, arthroscopic chondral resurfacing with microfracture and BioCartilage augmentation has been described for the treatment of focal chondral defects of the acetabulum. 22,26 This is usually performed in combination with FAIS treatment as an adjunct to arthroscopic hip preservation.…”

“…Most of the chondral grafting methodology has come from the knee, ankle (talus), and shoulder literature. [19][20][21]23,24,34,35 However, the potential instability induced by interportal capsulotomy without closure 36,37 can be detrimental to the existing joint architecture and possibly to the cartilage graft construct adherence and clot stability. Capsular plication in the hip joint is of paramount importance to minimize microinstability 38,39 and can potentially enhance the chance of a successful outcome after chondral resurfacing with autograft or allograft cartilage.…”

“…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.…”

Nanoscopic Single-Incision Autograft Cartilage Transfer (ACT)

“…also known as AutoCart using the GraftNet device (Arthrex, Naples, FL) for autograft harvest and BioCartilage (Arthrex) in addition to bone marrow concentrate to aid in graft incorporation and healing, has been described to treat osteochondral defects of the knee. 1 Osteochondral defects of the knee are a common cause of knee pain and dysfunction in adults. Several etiologies for the cause of these lesions has been proposed, including trauma, vascular insults, genetics, and endocrinopathies; however, the true etiology is unknown.…”