Cartilage lesions represent a significant clinical problem. Recent advances in our understanding of the functions of mesenchymal stem cells (MSC) have shown their chondrogenic potential. The use of autologous concentrated bone marrow aspirate represents an improvement on the currently available techniques for cartilage transplantation avoiding the first surgery for cartilage biopsy and cells cultivation.
A group of 25 patients with grade IV cartilage lesion of the knee, have been treated from at our Institution with MSC implantation. We prospectively followed up them for 24 months, surgery was performed with a mini arthrotomy approach and concentrated MSC were pasted into the lesion and covered with a collagen membrane sutured to the surrounding tissue. Bone marrow was harvested from the ipsilateral iliac crest subjected to concentration and activation prior to implantation. All patients followed the same specific rehabilitation program for a minimum of 6 months. IKDC, KOOS, Lysholm and Tegner scores were collected at pre-op and every 6 months post-operatively and at final follow up. All patients did MRI at 6,12 and 24 months. Second look arthroscopy and biopsies were done on four knees of these patients at 6 months and at 1 year post procedure .
Patients mean age was 40.6 years, all patients showed improvements in evaluation scores. Mean pre-op values were: IKDC subjective 52.3, KOOS Scores P=87.2/S=54.0/ADL=86.0/SP51/QOL= 41.8, Lysholm 64 and Tegner 3.2. At final follow-up mean scores were: IKDC subjective 76.7, KOOS P=95.7/S=87.0/ADL=96.5/SP=71.3/QOL=73.2, Lysholm 90 and Tegner 5.8. MRI showed good integration and coverage of the defect and no reaction of subchondral bone. No adverse reactions or post–op complication were noted in these patients. Second look arthroscopy and biopsies were done in 4 knees and revealed the formation of good cartilage type tissue with typical hyaline features particularly at longer follow-up times.
This study demonstrates that concentrated bone marrow aspirate with one step implantation of mesenchymal stem cell can be a viable alternative in the treatment grade IV chondral lesions of the knee. Furthermore this procedure offers the advantage of a lower cost if compared with standard A.C.I.
© 2010 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.