One-Stage Cartilage Repair Using a Hyaluronic Acid–Based Scaffold With Activated Bone Marrow–Derived Mesenchymal Stem Cells Compared With Microfracture

Gobbi, Alberto; Whyte, Graeme P.

doi:10.1177/0363546516656179

Cited by 184 publications

(139 citation statements)

References 55 publications

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“…These were conducted in either the knee [71, 72] or the ankle joint [73, 74] (Table 2). Microfracture was the main marrow stimulation technique, applied in three studies [71–73], subchondral drilling only once [74].…”

Section: Effects Of Bone Marrow Aspirate-enhanced Marrow Stimulatimentioning

confidence: 99%

“…The clinical outcome was not compared to a negative control group. Gobbi et al treated 50 patients with chondral lesions of the knee (ICRS grade IV) with microfracture (microfracture group; median lesion size of 4.5 cm 2 ) or a hyaluronan- (HA-) based scaffold plus BMAC (HA-BMAC group; median lesion size of 6.5 cm 2 ) [72]. BMA was centrifuged to obtain a concentration of bone marrow cells approximately 6 times the baseline value.…”

Section: Effects Of Bone Marrow Aspirate-enhanced Marrow Stimulatimentioning

confidence: 99%

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Bone Marrow Aspirate Concentrate-Enhanced Marrow Stimulation of Chondral Defects

Madry

Eichler

Orth

et al. 2017

Stem Cells International

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Mesenchymal stem cells (MSCs) from bone marrow play a critical role in osteochondral repair. A bone marrow clot forms within the cartilage defect either as a result of marrow stimulation or during the course of the spontaneous repair of osteochondral defects. Mobilized pluripotent MSCs from the subchondral bone migrate into the defect filled with the clot, differentiate into chondrocytes and osteoblasts, and form a repair tissue over time. The additional application of a bone marrow aspirate (BMA) to the procedure of marrow stimulation is thought to enhance cartilage repair as it may provide both an additional cell population capable of chondrogenesis and a source of growth factors stimulating cartilage repair. Moreover, the BMA clot provides a three-dimensional environment, possibly further supporting chondrogenesis and protecting the subchondral bone from structural alterations. The purpose of this review is to bridge the gap in our understanding between the basic science knowledge on MSCs and BMA and the clinical and technical aspects of marrow stimulation-based cartilage repair by examining available data on the role and mechanisms of MSCs and BMA in osteochondral repair. Implications of findings from both translational and clinical studies using BMA concentrate-enhanced marrow stimulation are discussed.

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Section: Effects Of Bone Marrow Aspirate-enhanced Marrow Stimulatimentioning

confidence: 99%

Section: Effects Of Bone Marrow Aspirate-enhanced Marrow Stimulatimentioning

confidence: 99%

Bone Marrow Aspirate Concentrate-Enhanced Marrow Stimulation of Chondral Defects

Madry

Eichler

Orth

et al. 2017

Stem Cells International

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“…Cell-based cartilage repair using biologic scaffolds in conjunction with BMAC has shown comparable medium-term clinical outcomes to ACI, and has the benefit of being a single-stage procedure that is less resource intensive. 3,6 It should be noted that although good to excellent medium-term outcomes have been shown with the use of HA-BMAC to treat cartilage injury within the knee, a similar outcome analysis is not yet available for the use of this technique in conjunction with a bony inlay to reconstitute subchondral bone loss. With regard to the choice of scaffold, a type I/III collagen graft, or similar material, may be used in place of the hyaluronic acidbased scaffold.…”

Section: Discussionmentioning

confidence: 99%

“…5 This technique has provided good to excellent clinical outcomes in a wide range of lesion sizes within the knee, including multicompartment lesions more than 20 cm 2 in size. 6 Minimally invasive techniques of cartilage repair are favored due to the lessened morbidity of surgery and the reduced postoperative recovery period. Arthroscopic cartilage restoration using an HA-BAMC has been described previously, and is used regularly by our institutions.…”

mentioning

confidence: 99%

Biologic Inlay Osteochondral Reconstruction: Arthroscopic One-Step Osteochondral Lesion Repair in the Knee Using Morselized Bone Grafting and Hyaluronic Acid-Based Scaffold Embedded With Bone Marrow Aspirate Concentrate

Sadlik¹,

Gobbi

Puszkarz³

et al. 2017

Arthroscopy Techniques

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Cartilage injury of the knee that is associated with significant subchondral bone loss can result in great morbidity, and treatment options that provide durable repair are limited. Osteochondral autograft and allograft reconstruction of these lesions has been used extensively; however, these techniques often require a more invasive surgical exposure, and restoring the natural articular surface radius of curvature can be challenging, particularly in larger lesions. Cell-based repair of these lesions, using autologous chondrocytes in conjunction with bone grafting, has been used with success, although this procedure requires the patient to undergo 2 operations, and access is often restricted due to the high associated costs. Comparable medium-term clinical outcomes have been shown with scaffold-associated mesenchymal stem cell grafting, and this cell-based procedure may also be performed arthroscopically to minimize patient morbidity. In cases of cartilage injury associated with bone loss, this procedure has great potential to repair osteochondral injury when used in conjunction with bone grafting. We present the one-step arthroscopic technique of biologic inlay osteochondral reconstruction in the knee, using an autologous bone graft and a hyaluronic acid-based scaffold embedded with bone marrow aspirate concentrate, to treat full-thickness cartilage lesions associated with significant subchondral bone loss.

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“…Natural polymers are limited to alginate [98,99,100,101], gelatin [102,103], agarose [104,105], hyaluronic acid [106], fibrin, and collagen [107]. The synthetic group is more diverse and generally includes poly( ɛ -caprolactone) [102,108], poly( l -lactic acid) [109,110], poly(lactic-co-glycolic acid) [111,112], poly(vinyl alcohol) [113], polyethylene glycol [114], pluronics [115], polyurethane [116], and self-assembling peptides [104].…”

Section: Tissue-engineered Constructsmentioning

confidence: 99%

Repair of Damaged Articular Cartilage: Current Approaches and Future Directions

Medvedeva

Grebenik

Gornostaeva

et al. 2018

IJMS

205

172

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Articular hyaline cartilage is extensively hydrated, but it is neither innervated nor vascularized, and its low cell density allows only extremely limited self-renewal. Most clinical and research efforts currently focus on the restoration of cartilage damaged in connection with osteoarthritis or trauma. Here, we discuss current clinical approaches for repairing cartilage, as well as research approaches which are currently developing, and those under translation into clinical practice. We also describe potential future directions in this area, including tissue engineering based on scaffolding and/or stem cells as well as a combination of gene and cell therapy. Particular focus is placed on cell-based approaches and the potential of recently characterized chondro-progenitors; progress with induced pluripotent stem cells is also discussed. In this context, we also consider the ability of different types of stem cell to restore hyaline cartilage and the importance of mimicking the environment in vivo during cell expansion and differentiation into mature chondrocytes.

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One-Stage Cartilage Repair Using a Hyaluronic Acid–Based Scaffold With Activated Bone Marrow–Derived Mesenchymal Stem Cells Compared With Microfracture

Cited by 184 publications

References 55 publications

Bone Marrow Aspirate Concentrate-Enhanced Marrow Stimulation of Chondral Defects

Bone Marrow Aspirate Concentrate-Enhanced Marrow Stimulation of Chondral Defects

Biologic Inlay Osteochondral Reconstruction: Arthroscopic One-Step Osteochondral Lesion Repair in the Knee Using Morselized Bone Grafting and Hyaluronic Acid-Based Scaffold Embedded With Bone Marrow Aspirate Concentrate

Repair of Damaged Articular Cartilage: Current Approaches and Future Directions

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