In this study we applied autologous fat tissue stromal vascular fraction (SVF) cells in combination with microfracturing technique in a 36-year-old man with an osteochondral lesion of the medial femoral condyle 8 months after the injury. Cell material was generated by fat tissue liposuction from the anterior abdominal wall with subsequent extraction of the SVF and injected through a mini-arthrotomy portal with subsequent fibrin sealant fixation. The follow-up period was 2 years. Clinical score improved from 23 to 96 according to IKDC and from 10 to 90 according to EQ-VAS at 24 months follow-up. Magnetic resonance imaging (MRI) before the surgery revealed an osteochondral lesion with development of significant trabecular edema that remained unchanged for 6 months despite conservative treatment. MRI 1 and 2 years after the surgery showed the recovery of the damaged cartilage thickness with somewhat uneven structure and a decrease in the trabecular edema of the femoral condyle. The use of SVF cells with fibrin sealant fixation might be a promising approach in the treatment of osteochondral joint lesions. Further studies are required.

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The case of joints of the upper and lower appendages is the matter for discussion of differences in mechanisms of therapeutic effect of the plasmolifting (PL). It involves 3–5 time injections of platelet mass extracted from autologous blood into injury area spaced a week apart. The ankle joint subjected to PL therapy, compared against knee, elbow and shoulder joints, shows an extremely low ability for restoration of its functionality. Therapeutic benefit is contributed by ability of biologically active substances (BAS) and cytokines released by platelets (Pl) for activation of metabolic processes within damaged tissues. In turn, it insures restoration of morphofunctional disorders of inflammatory genesis and reparative capabilities. Successive application of PL is directly dependent on the tissues that make up a certain joint. The positive effect of the introduction of Pl auto-suspension is determined by the presence of cytokine donor cells, especially platelet activation factor (PAF). Their sufficient amount triggers Pl granulation. An extensive capillary network results with a saturated blood supply and ensures access of granulocyte cells to the sanitized tissue. Besides, basophils and mast cells of connective tissue together with the endothelium of the above capillaries are also PAF sources. All of the above provides a positive therapeutic effect of the PL method on the knee, elbow and shoulder joints unlike the absence of its practical therapeutic effect on the ankle joint and Achilles tendon.