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

Abstract

BACKGROUND: Osteochondral injury is a very common orthopaedic pathology, mainly affecting young, active population, with limited current treatment options. Herein we are presenting cellular and early clinical data of a patient series treated for chronic osteochondral lesions in the knee with a filter-based intra-operative bone marrow aspirate (BMA) separation device. METHODS: Fifteen patients with chronic knee osteochondral lesions (60% females, 19-59 years) were included in this prospective case series. Filtered BMA (f-BMA), containing mesenchymal stem/stromal cells (MSCs), was combined with a biomimetic collagen-hydroxyapatite scaffold (CHAS) and implanted into the site of the lesion. Harvested BMA and postseparation f-BMA were analysed for blood cell counts, flow cytometry, and fibroblast colony forming units (CFU-Fs). Patients were followed for serious adverse events and graft failures. Clinical evaluation was assessed using the knee injury and osteoarthritis outcome score (KOOS). In 8 patients a magnetic resonance imaging (MRI)/arthroscopy were performed. RESULTS: Cell suspension contained 0.027% CD271 ? CD45 -7-AADcells, 0.15% CD73 ? CD90 ? CD105 ? cells and 0.0012% CFU-Fs of all nucleated cells with 86% viability. Filtration process resulted in 12.8 (4.0-40.8) fold enrichment in terms of CFU-F content in comparison to initial BMA. No serious adverse events related directly to the osteochondral treatment were reported. After an average follow-up of 20 months (14-25) all KOOS subscales (Symptoms/Pain/Daily activities/Sport and recreation/Quality of life) increased significantly from pre-operative 55/56/67/30/30 to post-operative 73/76/79/51/52 (p values \ 0.05), respectively. MRI or arthroscopic evaluation revealed nearly normal to normal overall International Cartilage Repair Society assessment in 7/8 patients. CONCLUSION: The filter-based BMA separation procedure significantly increased the frequency of mesenchymal stem/ stromal cells (MSCs), however their concentration was not increased. The clinical evaluation revealed high safety profile of the treatment and resulted in improved clinical status of the patients.

Current and novel theranostic modalities for knee osteoarthritis

“…In this regard, the efficacy of filtered bone marrow aspirate containing MSCs in combination with biomimetic collagen-hydroxyapatite scaffold in KOA was investigated on 15 patients. This research showed significant improvement in the status of the patients [92]. PRP is one of the cartilage growth factors which is rich in TGF-β, Koh et al reported that the injection of MSCs in combination with PRP into the joint cavity showed significant improvement in the treatment of OA [93].…”

Arthroscopic Fixation of Knee Femoral Condyle Osteochondritis Dissecans Fragment With Bone Marrow Aspirate Concentrate

“…7,8,10,11,21 There have been several clinical studies supporting the use of BMAC for the treatment of cartilage lesions. 9,10,[22][23][24][25] As the use of BMAC for osteochondral lesions continues to be evaluated, we offer a technique for use in treating OCD lesions, with tips from our experience in implementing this technique. Another technique has described in which the parent bone of an OCD undergoes microfracture to release mesenchymal cells on the parent bone.…”

“… 7 , 8 , 10 , 11 , 21 There have been several clinical studies supporting the use of BMAC for the treatment of cartilage lesions. 9 , 10 , 22 , 23 , 24 , 25 …”

Biomaterials augmented with filtered bone marrow aspirate for the treatment of talar osteochondral lesions. A comparison of clinical and cellular parameters

“…To emphasize the involvement of filtration in the concentration process, the expression filtered Bone Marrow Aspirate (fBMA) has been introduced. 7 Bone Marrow Aspirate Concentrate in the combination with biomaterials is becoming an increasingly studied and practiced approach in the orthopaedic surgery for the treatment of chondral and osteochondral lesions, which can greatly affect the patients' functioning and quality of life. [8][9][10] The rationale for BMAC augmentation is to leverage the established positive mechanisms of action of MSCs in cartilage regeneration by introducing additional MSCs at the lesion site.…”