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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 single-stage arthroscopic procedure.

SUBMITTER: Lavender C

PROVIDER: S-EPMC7029053 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:PurposeTo assess the postoperative objective, subjective, and functional outcomes as well as complication rates in osteochondral defect patients treated with bone marrow aspirate concentrate (BMAC) and cartilage-derived matrix (CDM) during knee arthroscopy.MethodsA retrospective chart review was performed for patients treated arthroscopically with BMAC and CDM between August 2015 and August 2018 and had more than 1-year follow-up. Demographic factors such as age, sex, body mass index, and comorbidities were collected for all patients. Size and location of the osteochondral lesions also were documented.ResultsA total of 14 patients were identified with a mean follow-up of 19 months. On average, patients were 34 years of age (range 16-58 years) and 43% were female. Postoperatively, knee flexion increased by 8° from 124° to 132° (P = .002). All patients regained full extension; however, 1 patient later acquired a 2° extension contracture after a traumatic event. The average hamstring strength significantly increased from 4.1 to 4.6 postoperatively (P = .33). The average quadriceps strength significantly increased from 4.0 to 4.5 postoperatively (P = .007). Mean visual analog scale scores significantly decreased postoperatively (4.5 vs 1.4; P = .001). There was a significant increase in Knee Outcome Survey Activities of Daily Living scores (53.8 vs 92.9; P = .007). Mean Knee Outcome Survey-Sports scores also increased, although this was nonsignificant (28.2 vs 79.5; P = .560). No significant differences were noted in pain and functional outcomes when stratified by the osteochondral defect size and location. Complications included a stitch abscess, Baker's cyst, and residual pain treated with hyaluronic acid injection.ConclusionsThis study demonstrated arthroscopic BMAC and CDM implantation appears to be safe and has the potential to improve patient outcomes in the short-term postoperative period.Level of evidenceIV, therapeutic case series.

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

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