Skip to main content
SpringerLink
Log in

One-step arthroscopic technique for the treatment of osteochondral lesions of the knee with bone-marrow-derived cells: three years results

  • Original Article
  • Published:
MUSCULOSKELETAL SURGERY Aims and scope Submit manuscript

Abstract

Osteochondral lesions of the knee (OLK) are a common cause of knee pain and associated diseases. A new bone-marrow-derived mesenchymal stem cells technique has been developed for the treatment of OLK. 30 patients with OLK underwent arthroscopic one-step procedure. The bone marrow was harvested from the patients’ posterior iliac crest and arthroscopically implanted with a scaffold into the lesion site. Clinical inspection and MRI were performed. Mean International Knee Documentation Committee (IKDC) score before surgery was 29.9 ± 13.2 and 85.4 ± 4.2 at 29 ± 4.1 months (p < 0.0005), while Knee injury and Osteoarthritis Outcome Score (KOOS) before surgery was 35.1 ± 11.9 and 87.3 ± 7.3 at 29 ± 4.1 months (p < 0.0005). Control MRI and bioptic samples showed an osteochondral regeneration of the lesion site. The one-step technique appears to be a good and reliable option for treatment of OLK at three years of follow-up.

Level of evidence Case series, Level IV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12

Similar content being viewed by others

References

  1. Widuchowski W, Widuchowski J, Trzaska T. Knee. Articular cartilage defects: study of 25,124 knee arthroscopies. Jun;14(3):177–182. [Epub 2007 Apr 10. 2007]

  2. Curl WW, Krome J, Gordon ES, Rushing J, Smith BP, Poehling GG (1997) Cartilage injuries: a review of 31,516 knee arthroscopies. Arthroscopy 13(4):456–460

    Article  PubMed  CAS  Google Scholar 

  3. Hjelle K, Solheim E, Strand T, Muri R, Brittberg M (2002) Articular cartilage defects in 1,000 knee arthroscopies. Arthroscopy 18(7):730–734

    Article  PubMed  Google Scholar 

  4. Papaioannou G, Demetropoulos CK, King YH (2010) Predicting the effects of knee focal articular surface injury with a patient-specific finite element model. Knee 17(1):61–68. [Epub 2009 May 23]

    Google Scholar 

  5. Hangody L, Vasarhelyi G, Hangody LR, Sukosd Z, Tibay G, Bartha L et al (2008) Autologous osteochondral grafting— technique and long-termresults. Injury 39(Suppl 1):S32–S39

    Article  PubMed  Google Scholar 

  6. Ferruzzi A, Buda R, Faldini C, Vannini F, Di Caprio F, Luciani D, Giannini S (2008) Autologous chondrocyte implantation in the knee joint: open compared with arthroscopic technique. Comparison at a minimum follow-up of five years. J Bone Joint Surg Am 90(Suppl 4):90–101

    Article  PubMed  Google Scholar 

  7. Marcacci M, Kon E, Delcogliano M, Filardo G, Busacca M, Zaffagnini S (2007) Arthroscopic autologous osteochondral grafting for cartilage defects of the knee: prospective study results at a minimum 7-year follow-up. Am J Sports Med 35(12):2014–2021. [Epub 2007 Aug 27]

    Google Scholar 

  8. Gobbi A (2009) Bathan L Biological approaches for cartilage repair. J Knee Surg. 22(1):36–44

    Article  PubMed  Google Scholar 

  9. Gobbi A, Nunag P, Malinowski K (2005) Treatment of full thickness chondral lesions of the knee with microfracture in a group of athletes. Knee Surg Sports Traumatol Arthrosc 13(3):213–221. [Epub 2004 May 14]

    Google Scholar 

  10. Peterson L, Brittberg M, Kiviranta I, Akerlund EL, Lindahl A (2002) Autologous chondrocyte transplantation. Biomechanics and long-term durability. Am J Sports Med 30(1):2–12

    Google Scholar 

  11. Magnussen RA, Dunn WR, Carey JL, Spindler KP (2008) Treatment of focal articular cartilage defects in the knee: a systematic review. Clin Orthop Relat Res 466(4):952–962. [Epub 2008 Jan 12]

    Google Scholar 

  12. Basad E, Ishaque B, Bachmann G, Stürz H, Steinmeyer J (2010) Matrix-induced autologous chondrocyte implantation versus microfracture in the treatment of cartilage defects of the knee: a 2-year randomised study. Knee Surg Sports Traumatol Arthrosc 18:519–527

    Article  PubMed  Google Scholar 

  13. Hangody L, Ráthonyi GK, Duska Z, Vásárhelyi G, Füles P, Módis L (2004) Autologous osteochondral mosaicplasty. Surgical technique. J Bone Joint Surg Am 86-A Suppl 1:65–72

    Google Scholar 

  14. Marcacci M, Kon E, Zaffagnini S, Filardo G, Delcogliano M, Neri MP, Iacono F, Hollander AP (2007) Arthroscopic second generation autologous chondrocyte implantation. Knee Surg Sports Traumatol Arthrosc 15(5):610–619

    Article  PubMed  Google Scholar 

  15. Kon E, Gobbi A, Filardo G, Delcogliano M, Zaffagnini S, Marcacci M (2009) Arthroscopic second generation autologous chondrocyte implantation compared with microfracture for chondral lesions of the knee: prospective nonrandomized study at 5 years. Am J Sports Med 37(1):33–41

    Article  PubMed  Google Scholar 

  16. Nehrer S, Domayer S, Dorotka R, Schatz K, Bindreiter U, Kotz R (2006) Three-year clinical outcome after chondrocyte transplantation using a hyaluronan matrix for cartilage repair. Eur J Radiol 57:3–8

    Article  PubMed  CAS  Google Scholar 

  17. Ossendorf C, Kaps C, Kreuz P, Burmester GR, Sittinger M, Erggelet C (2007) Treatment of posttraumatic and focal osteoarthritic cartilage defects of the knee with autologous polymer-based three-dimensional chondrocyte grafts: 2-year clinical results. Arthritis Res Ther. 9(2):R41

    Article  PubMed  Google Scholar 

  18. Selmi TA, Verdonk P, Chambat P et al (2008) Autologous chondrocyte implantation in a novel alginate-agarose hydrogel: outcome at two years. J Bone Joint Surg Br 90(5):597–604

    PubMed  CAS  Google Scholar 

  19. Giannini S, Buda R, Vannini F, Cavallo M, Grigolo B (2009) One-step bone marrow-derived cell transplantation in talar osteochondral lesions. Clin Orthop Relat Res 467(12):3307–3320

    Article  PubMed  Google Scholar 

  20. 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-A Suppl 2:45–57

    Google Scholar 

  21. Buda R, Vannini F, Grigolo B, Cenacchi A, DiCaprio F, Giannini S (2007) Ingegneria Tissutale: tecnica Chirurgica. J Orthopaed Traumatol 33(Suppl 1):S215–S222

    Google Scholar 

  22. Buda R, Di Caprio F, Cavallo M, Ruffilli A, Giannini S (2009) Artroscopia della caviglia: ankle arthroscopy. J Orthopaed Traumatol 35(Suppl. 1):S221–S225

    Google Scholar 

  23. Irrgang JJ, Anderson AF, Boland AL et al (2001) Development and validation of the International Knee Documentation Committee subjective knee form. Am J Sports Med 29(5):600–613

    PubMed  CAS  Google Scholar 

  24. Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD (1998) Knee Injury and Osteoarthritis Outcome Score (KOOS)—development of a self-administered outcome measure. J Orthop Sports Phys Ther 28(2):88–96

    PubMed  CAS  Google Scholar 

  25. Marlovits S, Singer P, Zeller P, Mandl I, Haller J, Trattnig S (2009) Evaluation and comparison of cartilage repair tissue of the patella and medial femoral condyle by using morphological MRI and biochemical zonal T2 mapping. Eur Radiol 19(5):1253–1262. [Epub 2008 Dec 23]

    Google Scholar 

  26. Brittberg M, Winalski CS (2003) Evaluation of cartilage injuries and repair. J Bone Joint Surg Am 85(Suppl 2):58–69

    PubMed  Google Scholar 

  27. Brittberg M, Lindahl A, Nilsson A, Ohlsson C, Isaksson O (1994) Peterson L Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. N Engl J Med 331:889–895

    Article  PubMed  CAS  Google Scholar 

  28. Brittberg M, Tallheden T, Sjogren-Jansson B, Lindahl A (2001) Peterson L Autologous chondrocytes used for articular cartilage repair: an update. Clin Orthop Relat Res 391:S337–S348

    Article  PubMed  Google Scholar 

  29. Peterson L, Brittberg M, Lindahl A (2003) Autologous chondrocyte transplantation of the ankle. Foot Ankle Clin 8:291–303

    Article  Google Scholar 

  30. Peterson L, Minas T, Brittberg M, Nilsson A, Sjogren-Jansson E (2000) Lindahl ATwo- to 9-year outcome after autologous chondrocyte transplantation of the knee. Clin Orthop Relat Res 374:212–234

    Article  PubMed  Google Scholar 

  31. Peterson L, Brittberg M, Kiviranta I, Akerlund EL (2002) Autologous chondrocyte transplantation. Biomechanics and long-term durability. Am J Sports Med 30:2–12

    PubMed  Google Scholar 

  32. Henderson I, Lavigne P, Valenzuela H (2007) Oakes B Autologous chondrocyte implantation: superior biologic properties of hyaline cartilage repairs. Clin Orthop Relat Res 455:253–261

    Article  PubMed  Google Scholar 

  33. Lindahl A, Brittberg M, Peterson L (2001) Health economics beneWts following autologous chondrocyte transplantation for patients with focal chondral lesions of the knee. Knee Surg Sports Traumatol Arthrosc 9:358–363

    Article  PubMed  CAS  Google Scholar 

  34. Minas T (1998) Chondrocyte implantation in the repair of chondral lesions of the knee: economics and quality of life. Am J Orthop 27:739–744

    PubMed  CAS  Google Scholar 

  35. Bosnakovski D, Mizuno M, Kim G, Takagi S, Okumura M, Fujinaga T (2006) Chondrogenic differentiation of bovine marrow mesenchymal stem cells (MSCs) in different hydrogels: influence of collagen type II extracellular matrix on MSC chondrogenesis. Biotechnol Bioeng 93:1152–1163

    Article  PubMed  CAS  Google Scholar 

  36. Dominici M, Pritchard C, Garlits JE, Hofmann TJ, Persons DA, Horwitz EM (2004) Hematopoietic cells and osteoblasts are derived from a common marrow progenitor after bone marrow transplantation. PNAS 101:11761–11766

    Article  PubMed  CAS  Google Scholar 

  37. Kacena MA, Gundberg CM, Horowitz MC (2006) A reciprocal regulatory interaction between megacaryocytes, bone cells and hematopoietic stem cells. Bone 39:978–984

    Article  PubMed  CAS  Google Scholar 

  38. Longobardi L, O’Rear L, Aakula S, Johnstone B, Shimer K, Chytil A, Horton WA, Moses HL, Spagnoli A (2006) Effect of IGF-I in the chondrogenesis of bone marrow mesenchymal stem cells in the presence or absence of TGF-beta signalling. J Bone Miner Res 21:626–636

    Article  PubMed  CAS  Google Scholar 

  39. Lucarelli E, Beccheroni A, Donati D, Sangiorgi L, Cenacchi A, Del Vento AM, Meotti C, Bertoja AZ, Giardino R, Fornasari PM, Mercuri M, Picci P (2003) Platelet-derived growth factors enhance proliferation of human stromal stem cells. Biomaterials 24:3095–3100

    Article  PubMed  CAS  Google Scholar 

  40. Olmsted-Davis EA, Gugala Z, Camargo F, Gannon FH, Jackson K, Kienstra KA, Shine HD, Lindsey RW, Hirschi KK, Goodell MA, Brenner MK, Davis AR (2003) Primitive adult hematopoietic stem cells can function as osteoblast precursors. PNAS 100:15877–15882

    Article  PubMed  CAS  Google Scholar 

  41. Taichman RS (2005) Blood and bone: two tissues whose fates are intertwined to create the hematopoietic stem-cell niche. Blood 105:2631–2639

    Article  PubMed  CAS  Google Scholar 

  42. Capone C, Frigerio S, Fumagalli S, Gelati M, Principato MC, Storini C, Montinaro M, Kraftsik R, De Curtis M, Parati E, De Simoni MG (2007) Neurosphere-derived cells exert a neuroprotective action by changing the ischemic microenvironment. PLoS ONE 2:e373

    Article  PubMed  Google Scholar 

  43. Lepore AC, Han SS, Tiler-Polsz CJ, Cai J, Rao MS, Fischer I (2004) Transplantation into the adult CNS. Neuron Glia Biol. 1:113–126

    Article  PubMed  Google Scholar 

  44. Kon E, Verdonk P, Condello V, Delcogliano M, Dhollander A, Filardo G, Pignotti E, Marcacci M (2009) Matrix-assisted autologous chondrocyte transplantation for the repair of cartilage defects of the knee: systematic clinical data review and study quality analysis. Am J Sports Med 37 Suppl 1:156–66S. [Epub 2009 Oct 27]

    Google Scholar 

  45. Di Martino A, Liverani L, Rainer A, Salvatore G, Trombetta M, Denaro V (2011) Electrospun scaffolds for bone tissue engineering. Musc Surg 95(2):69–80. doi:10.1007/s12306-011-0097-8

    Article  Google Scholar 

  46. Tigani D, Rimondi E, Trentani P, Ansaloni M, Amendola L, Testi D (2011) Three-dimensional analysis of image-free navigation system for total knee arthroplasty. Musc Surg 95(2):81–87. doi:10.1007/s12306-010-0090-7

    Article  CAS  Google Scholar 

  47. Cenni Elisabetta, Savarino Lucia (2010) Francesca Perut. Caterina Fotia and Sofia Avnet, et al Background and rationale of platelet gel in orthopaedic surgery Musc Surg 94(1):1–8

    Google Scholar 

  48. Paderni S, Terzi S, Amendola L (2009) Major defect treatment with an osteoconductive bone substitute. Musc Surg 93(2):89–96

    Article  Google Scholar 

  49. Notarnicola A, Moretti L, Tafuri S, Vacca A, Marella G, Moretti B (2011) Postoperative pain monitor after total knee replacement. Musc Surg 95(1):19–24. doi:10.1007/s12306-011-0102

    Article  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Clinical Orthopaedic and Traumatology Unit I, Rizzoli Orthopaedic Institute, via G.C. Pupilli n.1, Bologna, Italy

    Roberto Buda, Francesca Vannini, Marco Cavallo, Matteo Baldassarri, Deianira Luciani, Antonio Mazzotti, Camilla Pungetti, Alessandra Olivieri & Sandro Giannini

Authors
  1. Roberto Buda
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Francesca Vannini
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marco Cavallo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Matteo Baldassarri
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Deianira Luciani
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Antonio Mazzotti
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Camilla Pungetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Alessandra Olivieri
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Sandro Giannini
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marco Cavallo.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Buda, R., Vannini, F., Cavallo, M. et al. One-step arthroscopic technique for the treatment of osteochondral lesions of the knee with bone-marrow-derived cells: three years results. Musculoskelet Surg 97, 145–151 (2013). https://doi.org/10.1007/s12306-013-0242-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12306-013-0242-7

Keywords

Search

Navigation