One-step Bone Marrow-derived Cell Transplantation in Talar Osteochondral Lesions
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The ideal treatment of osteochondral lesions is debatable. Although autologous chondrocyte implantation provides pain relief, the need for two operations and high costs has prompted a search for alternatives. Bone marrow-derived cells may represent the future in osteochondral repair. Using a device to concentrate bone marrow-derived cells and collagen powder or hyaluronic acid membrane as scaffolds for cell support and platelet gel, a one-step arthroscopic technique was developed for cartilage repair. We performed an in vitro preclinical study to verify the capability of bone marrow-derived cells to differentiate into chondrogenic and osteogenic lineages and to be supported onto scaffolds. In a prospective clinical study, we investigated the ability of this technique to repair talar osteochondral lesions in 48 patients. Minimum followup was 24 months (mean, 29 months; range, 24–35 months). Clinical results were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) score and the influence of scaffold type, lesion area, previous surgeries, and lesion depth was considered. MRI and histologic evaluation were performed. The AOFAS score improved from 64.4 ± 14.5 to 91.4 ± 7.7. Histologic evaluation showed regenerated tissue in various degrees of remodeling although none showed entirely hyaline cartilage. These data suggest the one-step technique is an alternative for cartilage repair, permitting improved functional scores and overcoming the drawbacks of previous techniques.
Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
KeywordsCartilage Repair Autologous Chondrocyte Implantation Osteochondral Lesion Talar Dome Bone Marrow Concentrate
We thank Carola Cavallo, PhD, for bioptic evaluation and preclinical analysis; Annarita Cenacchi, MD, and Annalisa Gabriele, MD, Immunohematology and Transfusional Service, Istituto Ortopedico Rizzoli, for bone marrow harvesting and concentration procedures; and Keith Smith for English revision.
- 4.Bartlett W, Skinner JA, Gooding CR, Carrington RW, Flanagan AM, Briggs TW, Bentley G. Autologous chondrocyte implantation versus matrix-induced autologous chondrocyte implantation for osteochondral defects of the knee: a prospective, randomised study. J Bone Joint Surg Br. 2005;87:640–645.CrossRefPubMedGoogle Scholar
- 8.Bosnakovski D, Mizuno M, Kim G, Takagi S, Okumura M, Fujinaga T. Chondrogenic differentiation of bovine marrow mesenchymal stem cells (MSCs) in different hydrogels: influence of collagen type II extracellular matrix on MSC chondrogenesis. Biotechnol Bioeng. 2006;93:1152–1163.CrossRefPubMedGoogle Scholar
- 23.Giannini S, Buda R, Faldini C, Vannini F, Bevoni R, Grandi G, Grigolo B, Berti L. Surgical treatment of osteochondral lesions of the talus (OLT) in young and active patients: guidelines for treatment and evolution of the technique. J Bone Joint Surg Am. 2005;87(suppl 2):28–41.CrossRefPubMedGoogle Scholar
- 27.Gobbi A, Francisco RA, Lubowitz JH, Allegra F, Canata G. Osteochondral lesions of the talus: randomized controlled trial comparing chondroplasty, microfracture, and osteochondral autograft transplantation. Arthroscopy. 2006;22:1085–1092. Erratum in: Arthroscopy. 2008;24:A16.PubMedCrossRefGoogle Scholar
- 41.Mainil-Varlet P, Aigner T, Brittberg M, Bullough P, Hollander A, Hunziker E, Kandel R, Nehrer S, Pritzker K, Roberts S, Stauffer E; International Cartilage Repair Society. Histological assessment of cartilage repair: a report by the Histology Endpoint Committee of the International Cartilage Repair Society (ICRS). J Bone Joint Surg Am. 2003;85:45–57.CrossRefPubMedGoogle Scholar
- 47.Nair MB, Varma HK, John A. Platelet-rich plasma and fibrin glue-coated bioactive ceramics enhance growth and differentiation of goat bone marrow-derived stem cells. Tissue Eng. 2009;15:1–13.Google Scholar