Orthobiologics for Focal Articular Cartilage Defects

Management of osteoarthritis - biological approaches: current concepts

“…However, studies have demonstrated that BM-MSCs comprise merely 0.001%–0.01% of mononuclear cells within bone marrow aspirate after density gradient centrifugation to remove granulocytes, red blood cells and immature myeloid precursors 38 39. Numerous growth factors, including many of the same factors found in PRP, have been identified in BMAC but in higher quantities 40 41. TGF-β superfamily of factors which have been linked to chondrocyte proliferation, and PDGF thought to promote wound healing, collagen synthesis and suppression of inflammatory mediators, such as IL-1β, insulin growth factor-1, fibroblast growth factor-18, bone morphogenetic protein-2 (BMP2) and BMP-7, among others, are present in higher quantities in BMAC than in PRP 33 42–45…”

Every new technique either conservative or surgical is good?

“…Orthobiologics used for cartilage defects include bone marrow aspirate concentrate, adipose-derived mesenchymal stem cells, PRP, and micronized allogeneic cartilage. [5] There is conflicting evidence regarding the use of orthobiologics for osteoarthritis and focal chondral defects. [6] Although positive results are being reported in the pre-clinical setup, more clinical data are required in order to make a conclusion on this new concept.…”

Recent advances and future trends in knee arthroscopy

“…Human studies with scaffolds have shown complete defect filling in 80-100% of patients. [65] Clinical improvement has been reported in up to 100% patients at 5 years, and on second look arthroscopy was found to have regenerated near normal hyaline cartilage. [66] BMAC also been reported to give better results in OCA transplants in terms of graft incorporation and healing when used as an adjunct.…”

“…It has been used in conjunction with micronized allograft articular cartilage, fibrin glue, scaffolds, and demineralized bone matrix for osteochondral defects; all with mixed results. [65] BMP-4 and BMP-7 are the two main growth factors which are tested in animal models and have shown good cartilage growth and hyaline cartilage differentiation. [65] The role of limb realignment including high tibial osteotomy as an adjunct to cartilage repair is important.…”