Skip to main content
Top
Published in: HSS Journal ® 1/2019

01-02-2019 | Evidence Based Review in Orthopedics

The Use of Bone Marrow Concentrate in the Treatment of Full-Thickness Chondral Defects

Authors: John M. Apostolakos, MD, MPH, Lionel Lazaro, MD, Riley J. Williams, MD

Published in: HSS Journal ® | Issue 1/2019

Login to get access

Abstract

This article is a critical analysis of a study, “Minimally Manipulated Bone Marrow Concentrate Compared with Microfracture Treatment of Full-Thickness Chondral Defects: A One-Year Study in an Equine Model,” by Chu et al. (J Bone Joint Surg Am. 100(2):138–146, 2018). The investigation compared two interventions in the management of full-thickness chondral defects in an equine model: autologous bone marrow concentrate without concomitant microfracture treatment versus microfracture treatment alone. This review analyzes the methodology and results of their investigation and examines how their findings may influence the continued development of therapeutic options for full-thickness cartilage injuries. The study utilized in vitro analysis, arthroscopic assessment, magnetic resonance imaging (MRI) evaluation, and histological analysis to compare the treatments and their influence on the quality of cartilage repair. Although Chu et al. reported similar results between groups, their findings offer insight into the role of arthroscopy, MRI, and histology in the evaluation of repair quality. We compare their findings to those of similar investigations, highlighting the limited therapeutic options and variable clinical outcomes related to the treatment of full-thickness articular cartilage defects.
Appendix
Available only for authorised users
Literature
1.
go back to reference Bae DK, Yoon KH, Song SJ. Cartilage healing after microfracture in osteoarthritic knees. Arthroscopy. 2006;22(4):367–374.CrossRefPubMed Bae DK, Yoon KH, Song SJ. Cartilage healing after microfracture in osteoarthritic knees. Arthroscopy. 2006;22(4):367–374.CrossRefPubMed
3.
go back to reference Caplan AI. Review: mesenchymal stem cells: cell-based reconstructive therapy in orthopedics. Tissue Eng. 2005;11(7–8):1198–1211.CrossRefPubMed Caplan AI. Review: mesenchymal stem cells: cell-based reconstructive therapy in orthopedics. Tissue Eng. 2005;11(7–8):1198–1211.CrossRefPubMed
4.
go back to reference Chu CR, Fortier LA, Williams A, et al. Minimally manipulated bone marrow concentrate compared with microfracture treatment of full-thickness chondral defects: a one-year study in an equine model. J Bone Joint Surg Am. 2018;100(2):138–146.CrossRefPubMed Chu CR, Fortier LA, Williams A, et al. Minimally manipulated bone marrow concentrate compared with microfracture treatment of full-thickness chondral defects: a one-year study in an equine model. J Bone Joint Surg Am. 2018;100(2):138–146.CrossRefPubMed
5.
go back to reference Dominici M, Le Blanc K, Mueller I, et al. Minimal criteria for defining multipotent mesenchymal stromal cells. The International Society for Cellular Therapy position statement. Cytotherapy. 2006;8(4):315–317.CrossRefPubMed Dominici M, Le Blanc K, Mueller I, et al. Minimal criteria for defining multipotent mesenchymal stromal cells. The International Society for Cellular Therapy position statement. Cytotherapy. 2006;8(4):315–317.CrossRefPubMed
6.
go back to reference Fortier LA, Potter HG, Rickey EJ, et al. Concentrated bone marrow aspirate improves full-thickness cartilage repair compared with microfracture in the equine model. J Bone Joint Surg Am. 2010;92(10):1927–1937.CrossRefPubMed Fortier LA, Potter HG, Rickey EJ, et al. Concentrated bone marrow aspirate improves full-thickness cartilage repair compared with microfracture in the equine model. J Bone Joint Surg Am. 2010;92(10):1927–1937.CrossRefPubMed
7.
go back to reference Gobbi A, Whyte GP. One-stage cartilage repair using a hyaluronic acid-based scaffold with activated bone marrow-derived mesenchymal stem cells compared with microfracture: five-year follow-up. Am J Sports Med. 2016;44(11):2846–2854.CrossRefPubMed Gobbi A, Whyte GP. One-stage cartilage repair using a hyaluronic acid-based scaffold with activated bone marrow-derived mesenchymal stem cells compared with microfracture: five-year follow-up. Am J Sports Med. 2016;44(11):2846–2854.CrossRefPubMed
8.
go back to reference Gobbi A, Karnatzikos G, Scotti C, Mahajan V, Mazzucco L, Grigolo B. One-step cartilage repair with bone marrow aspirate concentrated cells and collagen matrix in full-thickness knee cartilage lesions: results at 2-year follow-up. Cartilage. 2011;2(3):286–299.CrossRefPubMedPubMedCentral Gobbi A, Karnatzikos G, Scotti C, Mahajan V, Mazzucco L, Grigolo B. One-step cartilage repair with bone marrow aspirate concentrated cells and collagen matrix in full-thickness knee cartilage lesions: results at 2-year follow-up. Cartilage. 2011;2(3):286–299.CrossRefPubMedPubMedCentral
9.
go back to reference Gobbi A, Karnatzikos G, Sankineani SR. One-step surgery with multipotent stem cells for the treatment of large full-thickness chondral defects of the knee. Am J Sports Med. 2014;42(3):648–657.CrossRefPubMed Gobbi A, Karnatzikos G, Sankineani SR. One-step surgery with multipotent stem cells for the treatment of large full-thickness chondral defects of the knee. Am J Sports Med. 2014;42(3):648–657.CrossRefPubMed
10.
go back to reference Kim HK, Moran ME, Salter RB. The potential for regeneration of articular cartilage in defects created by chondral shaving and subchondral abrasion. An experimental investigation in rabbits. J Bone Joint Surg Am. 1991;73(9):1301–1315.CrossRefPubMed Kim HK, Moran ME, Salter RB. The potential for regeneration of articular cartilage in defects created by chondral shaving and subchondral abrasion. An experimental investigation in rabbits. J Bone Joint Surg Am. 1991;73(9):1301–1315.CrossRefPubMed
11.
go back to reference Kreuz PC, Erggelet C, Steinwachs MR, et al. Is microfracture of chondral defects in the knee associated with different results in patients aged 40 years or younger? Arthroscopy. 2006;22(11):1180–1186.CrossRefPubMed Kreuz PC, Erggelet C, Steinwachs MR, et al. Is microfracture of chondral defects in the knee associated with different results in patients aged 40 years or younger? Arthroscopy. 2006;22(11):1180–1186.CrossRefPubMed
12.
go back to reference Kreuz PC, Steinwachs MR, Erggelet C, et al. Results after microfracture of full-thickness chondral defects in different compartments in the knee. Osteoarthritis Cartilage. 2006;14(11):1119–1125.CrossRefPubMed Kreuz PC, Steinwachs MR, Erggelet C, et al. Results after microfracture of full-thickness chondral defects in different compartments in the knee. Osteoarthritis Cartilage. 2006;14(11):1119–1125.CrossRefPubMed
13.
go back to reference Madry H, Orth P, Cucchiarini M. Role of the subchondral bone in articular cartilage degeneration and repair. J Am Acad Orthop Surg. 2016;24(4):e45–46.CrossRefPubMed Madry H, Orth P, Cucchiarini M. Role of the subchondral bone in articular cartilage degeneration and repair. J Am Acad Orthop Surg. 2016;24(4):e45–46.CrossRefPubMed
14.
go back to reference Magnussen RA, Dunn WR, Carey JL, Spindler KP. Treatment of focal articular cartilage defects in the knee: a systematic review. Clin Orthop Relat Res. 2008;466(4):952–962.CrossRefPubMedPubMedCentral Magnussen RA, Dunn WR, Carey JL, Spindler KP. Treatment of focal articular cartilage defects in the knee: a systematic review. Clin Orthop Relat Res. 2008;466(4):952–962.CrossRefPubMedPubMedCentral
15.
go back to reference Mankin HJ. The reaction of articular cartilage to injury and osteoarthritis (first of two parts). New Engl J Med. 12 1974;291(24):1285–1292. Mankin HJ. The reaction of articular cartilage to injury and osteoarthritis (first of two parts). New Engl J Med. 12 1974;291(24):1285–1292.
16.
go back to reference Mankin HJ. The response of articular cartilage to mechanical injury. J Bone Joint Surg Am. 1982;64(3):460–466.CrossRefPubMed Mankin HJ. The response of articular cartilage to mechanical injury. J Bone Joint Surg Am. 1982;64(3):460–466.CrossRefPubMed
17.
go back to reference Minas T, Gomoll AH, Rosenberger R, Royce RO, Bryant T. Increased failure rate of autologous chondrocyte implantation after previous treatment with marrow stimulation techniques. Am J Sports Med. 2009;37(5):902–908.CrossRefPubMed Minas T, Gomoll AH, Rosenberger R, Royce RO, Bryant T. Increased failure rate of autologous chondrocyte implantation after previous treatment with marrow stimulation techniques. Am J Sports Med. 2009;37(5):902–908.CrossRefPubMed
18.
go back to reference Mithoefer K, Williams RJ, 3rd, Warren RF, et al. The microfracture technique for the treatment of articular cartilage lesions in the knee. A prospective cohort study. J Bone Joint Surg Am. 2005;87(9):1911–1920.CrossRefPubMed Mithoefer K, Williams RJ, 3rd, Warren RF, et al. The microfracture technique for the treatment of articular cartilage lesions in the knee. A prospective cohort study. J Bone Joint Surg Am. 2005;87(9):1911–1920.CrossRefPubMed
19.
go back to reference Mithoefer K, Venugopal V, Manaqibwala M. Incidence, Degree, and clinical effect of subchondral bone overgrowth after microfracture in the knee. Am J Sports Med. 2016;44(8):2057–2063.CrossRefPubMed Mithoefer K, Venugopal V, Manaqibwala M. Incidence, Degree, and clinical effect of subchondral bone overgrowth after microfracture in the knee. Am J Sports Med. 2016;44(8):2057–2063.CrossRefPubMed
20.
go back to reference Pittenger MF, Mackay AM, Beck SC, et al. Multilineage potential of adult human mesenchymal stem cells. Science. 1999;284(5411):143–147.CrossRefPubMed Pittenger MF, Mackay AM, Beck SC, et al. Multilineage potential of adult human mesenchymal stem cells. Science. 1999;284(5411):143–147.CrossRefPubMed
21.
go back to reference Schmitz N, Laverty S, Kraus VB, Aigner T. Basic methods in histopathology of joint tissues. Osteoarthritis Cartilage. 2010;18 Suppl 3:S113–116.CrossRefPubMed Schmitz N, Laverty S, Kraus VB, Aigner T. Basic methods in histopathology of joint tissues. Osteoarthritis Cartilage. 2010;18 Suppl 3:S113–116.CrossRefPubMed
22.
go back to reference Shapiro F, Koide S, Glimcher MJ. Cell origin and differentiation in the repair of full-thickness defects of articular cartilage. J Bone Joint Surg Am. 1993;75(4):532–553.CrossRefPubMed Shapiro F, Koide S, Glimcher MJ. Cell origin and differentiation in the repair of full-thickness defects of articular cartilage. J Bone Joint Surg Am. 1993;75(4):532–553.CrossRefPubMed
23.
go back to reference Squires GR, Okouneff S, Ionescu M, Poole AR. The pathobiology of focal lesion development in aging human articular cartilage and molecular matrix changes characteristic of osteoarthritis. Arthritis Rheum. 2003;48(5):1261–1270.CrossRefPubMed Squires GR, Okouneff S, Ionescu M, Poole AR. The pathobiology of focal lesion development in aging human articular cartilage and molecular matrix changes characteristic of osteoarthritis. Arthritis Rheum. 2003;48(5):1261–1270.CrossRefPubMed
24.
go back to reference Steadman JR, Rodkey WG, Rodrigo JJ. Microfracture: surgical technique and rehabilitation to treat chondral defects. Clin Orthop Relat Res. 2001(391 Suppl):S362–369. Steadman JR, Rodkey WG, Rodrigo JJ. Microfracture: surgical technique and rehabilitation to treat chondral defects. Clin Orthop Relat Res. 2001(391 Suppl):S362–369.
25.
go back to reference Watts AE, Ackerman-Yost JC, Nixon AJ. A comparison of three-dimensional culture systems to evaluate in vitro chondrogenesis of equine bone marrow-derived mesenchymal stem cells. Tissue Eng Part A. 2013;19(19–20):2275–2283.CrossRefPubMedPubMedCentral Watts AE, Ackerman-Yost JC, Nixon AJ. A comparison of three-dimensional culture systems to evaluate in vitro chondrogenesis of equine bone marrow-derived mesenchymal stem cells. Tissue Eng Part A. 2013;19(19–20):2275–2283.CrossRefPubMedPubMedCentral
26.
go back to reference Widuchowski W, Widuchowski J, Trzaska T. Articular cartilage defects: study of 25,124 knee arthroscopies. Knee. 2007;14(3):177–182.CrossRefPubMed Widuchowski W, Widuchowski J, Trzaska T. Articular cartilage defects: study of 25,124 knee arthroscopies. Knee. 2007;14(3):177–182.CrossRefPubMed
27.
go back to reference Wilke MM, Nydam DV, Nixon AJ. Enhanced early chondrogenesis in articular defects following arthroscopic mesenchymal stem cell implantation in an equine model. J Orthop Res. 2007;25(7):913–925.CrossRefPubMed Wilke MM, Nydam DV, Nixon AJ. Enhanced early chondrogenesis in articular defects following arthroscopic mesenchymal stem cell implantation in an equine model. J Orthop Res. 2007;25(7):913–925.CrossRefPubMed
Metadata
Title
The Use of Bone Marrow Concentrate in the Treatment of Full-Thickness Chondral Defects
Authors
John M. Apostolakos, MD, MPH
Lionel Lazaro, MD
Riley J. Williams, MD
Publication date
01-02-2019
Publisher
Springer US
Published in
HSS Journal ® / Issue 1/2019
Print ISSN: 1556-3316
Electronic ISSN: 1556-3324
DOI
https://doi.org/10.1007/s11420-018-9647-z

Other articles of this Issue 1/2019

HSS Journal ® 1/2019 Go to the issue

Opioid prescribing and pain management / commentary

Opioids and Ethics: Is Opioid-Free the Only Responsible Arthroplasty?