Abstract
Purpose
To determine whether microfracture with bone marrow aspirate concentrate (BMAC) improves functional outcome and cartilage regeneration better than microfracture alone in patients undergoing high tibial osteotomy (HTO) for medial unicompartmental osteoarthritis (OA).
Methods
Among 436 patients treated with HTO for medial unicompartmental OA with varus deformity between 2010 and 2016, clinical outcomes were retrospectively compared between the microfracture alone group (group I, 43 cases) and microfracture with BMAC augmentation group (group II, 48 cases). Of these, 64 patients underwent a second-look arthroscopic assessment. Clinical outcomes were compared based on the Knee Society Score (KSS), International Knee Documentation Committee (IKDC) subjective score, and Western Ontario and McMaster Universities Arthritis Index (WOMAC). Cartilage regeneration was assessed according to Koshino’s staging system and the International Cartilage Repair Society (ICRS) Cartilage Repair Assessment (CRA) grading system.
Results
At the last follow-up, there were no significant intergroup differences in terms of KSS for pain and function (p > 0.05). Moreover, WOMAC scores were similar between the two groups (p > 0.05). Regarding second-look arthroscopy findings, according to Koshino’s staging system, there was no significant intergroup difference in terms of defect coverage (p = 0.187). However, group II showed a significantly better mean CRA score than group I (p = 0.035).
Conclusion
There were no significant differences in clinical outcomes and cartilage regeneration between the groups. However, the CRA score was significantly higher with BMAC augmentation and microfracture than microfracture alone. Therefore, BMAC augmentation had a synergistic effect for a better cartilage regeneration, although studies with a longer follow-up might help to confirm whether microfracture with BMAC augmentation would ensure better clinical outcomes than microfracture alone for the treatment of knee OA.
Similar content being viewed by others
References
Akizuki S, Yasukawa Y, Takizawa T (1997) Does arthroscopic abrasion arthroplasty promote cartilage regeneration in osteoarthritic knees with eburnation? A prospective study of high tibial osteotomy with abrasion arthroplasty versus high tibial osteotomy alone. Arthroscopy 13:9–17
Bedi A, Feeley BT, Williams RJ 3rd (2010) Management of articular cartilage defects of the knee. J Bone Jt Surg Am 92:994–1009
Biant LC, McNicholas MJ, Sprowson AP, Spalding T (2015) The surgical management of symptomatic articular cartilage defects of the knee: consensus statements from United Kingdom knee surgeons. Knee 22:446–449
Bode G, Ogon P, Pestka J, Zwingmann J, Feucht M, Sudkamp N et al (2015) Clinical outcome and return to work following single-stage combined autologous chondrocyte implantation and high tibial osteotomy. Int Orthop 39:689–696
Brittberg M, Winalski CS (2003) Evaluation of cartilage injuries and repair. J Bone Jt Surg Am 85-A(Suppl 2):58–69
Cavallo M, Sayyed-Hosseinian SH, Parma A, Buda R, Mosca M, Giannini S (2018) Combination of high tibial osteotomy and autologous bone marrow derived cell implantation in early osteoarthritis of knee: a preliminary study. Arch Bone Jt Surg 6:112–118
Cerejo R, Dunlop DD, Cahue S, Channin D, Song J, Sharma L (2002) The influence of alignment on risk of knee osteoarthritis progression according to baseline stage of disease. Arthritis Rheum 46:2632–2636
Chadli L, Cottalorda J, Delpont M, Mazeau P, Thouvenin Y, Louahem D (2017) Autologous osteochondral mosaicplasty in osteochondritis dissecans of the patella in adolescents. Int Orthop 41:197–202
Cotter EJ, Wang KC, Yanke AB, Chubinskaya S (2018) Bone marrow aspirate concentrate for cartilage defects of the knee: from bench to bedside evidence. Cartilage 9:161–170
Dettoni F, Bonasia DE, Castoldi F, Bruzzone M, Blonna D, Rossi R (2010) High tibial osteotomy versus unicompartmental knee arthroplasty for medial compartment arthrosis of the knee: a review of the literature. Iowa Orthop J 30:131–140
Ferruzzi A, Buda R, Cavallo M, Timoncini A, Natali S, Giannini S (2014) Cartilage repair procedures associated with high tibial osteotomy in varus knees: clinical results at 11 years' follow-up. Knee 21:445–450
Floerkemeier S, Staubli AE, Schroeter S, Goldhahn S, Lobenhoffer P (2013) Outcome after high tibial open-wedge osteotomy: a retrospective evaluation of 533 patients. Knee Surg Sports Traumatol Arthrosc 21:170–180
Fujisawa Y, Masuhara K, Shiomi S (1979) The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin North Am 10:585–608
Gobbi A, Whyte GP (2016) 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 44:2846–2854
Huh SW, Shetty AA, Ahmed S, Lee DH, Kim SJ (2016) Autologous bone-marrow mesenchymal cell induced chondrogenesis (MCIC). J Clin Orthop Trauma 7:153–156
Hirschmann MT, Moser LB, Amsler F, Behrend H, Leclerq V, Hess S (2019) Functional knee phenotypes: a novel classification for phenotyping the coronal lower limb alignment based on the native alignment in young non-osteoarthritic patients. Knee Surg Sports Traumatol Arthrosc 27(5):1394–1402
Jung WH, Takeuchi R, Chun CW, Lee JS, Jeong JH (2015) Comparison of results of medial opening-wedge high tibial osteotomy with and without subchondral drilling. Arthroscopy 31:673–679
Kahlenberg CA, Nwachukwu BU, Hamid KS, Steinhaus ME, Williams RJ 3rd (2017) Analysis of outcomes for high tibial osteotomies performed with cartilage restoration techniques. Arthroscopy 33:486–492
Kim KI, Seo MC, Song SJ, Bae DK, Kim DH, Lee SH (2017) Change of chondral lesions and predictive factors after medial open-wedge high tibial osteotomy with a locked plate system. Am J Sports Med 45:1615–1621
Kim MS, Koh IJ, Choi YJ, Pak KH, In Y (2017) Collagen augmentation improves the quality of cartilage repair after microfracture in patients undergoing high tibial osteotomy: a randomized controlled trial. Am J Sports Med 45:1845–1855
Kim YS, Koh YG (2018) Comparative matched-pair analysis of open-wedge high tibial osteotomy with versus without an injection of adipose-derived mesenchymal stem cells for varus knee osteoarthritis: clinical and second-look arthroscopic results. Am J Sports Med 46:2669–2677
Koshino T, Wada S, Ara Y, Saito T (2003) Regeneration of degenerated articular cartilage after high tibial valgus osteotomy for medial compartmental osteoarthritis of the knee. Knee 10:229–236
Kumagai K, Akamatsu Y, Kobayashi H, Kusayama Y, Saito T (2018) Mosaic osteochondral autograft transplantation versus bone marrow stimulation technique as a concomitant procedure with opening-wedge high tibial osteotomy for spontaneous osteonecrosis of the medial femoral condyle. Arthroscopy 34(1):233–240
Matsunaga D, Akizuki S, Takizawa T, Yamazaki I, Kuraishi J (2007) Repair of articular cartilage and clinical outcome after osteotomy with microfracture or abrasion arthroplasty for medial gonarthrosis. Knee 14:465–471
Pascale W, Luraghi S, Perico L, Pascale V (2011) Do microfractures improve high tibial osteotomy outcome? Orthopedics 34:e251–255
Redler LH, Caldwell JM, Schulz BM, Levine WN (2012) Management of articular cartilage defects of the knee. Phys Sportsmed 40:20–35
Siebold R, Karidakis G, Feil S, Fernandez F (2016) Second-look assessment after all-arthroscopic autologous chondrocyte implantation with spheroides at the knee joint. Knee Surg Sports Traumatol Arthrosc 24:1678–1685
Spahn G, Hofmann GO, von Engelhardt LV, Li M, Neubauer H, Klinger HM (2013) The impact of a high tibial valgus osteotomy and unicondylar medial arthroplasty on the treatment for knee osteoarthritis: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 21:96–112
Acknowledgements
All named authors had substantially contributed to the research and manuscript conducting. We would like to thank Editage (www.editage.co.kr) for English language editing.
Funding
This research did not receive any specific grants.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors have no relevant conflicts of interest to declare.
Ethical approval
The study was approved by the Human Ethics Committee at Chonnam National University Hwasun Hospital.
Informed consent
Written informed consent was obtained from all patients.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Jin, QH., Chung, YW., Na, SM. et al. Bone marrow aspirate concentration provided better results in cartilage regeneration to microfracture in knee of osteoarthritic patients. Knee Surg Sports Traumatol Arthrosc 29, 1090–1097 (2021). https://doi.org/10.1007/s00167-020-06099-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-020-06099-x