Biologic Inlay Osteochondral Reconstruction: Arthroscopic One-Step Osteochondral Lesion Repair in the Knee Using Morselized Bone Grafting and Hyaluronic Acid-Based Scaffold Embedded With Bone Marrow Aspirate Concentrate

Abstract

Cartilage injury of the knee that is associated with significant subchondral bone loss can result in great morbidity, and treatment options that provide durable repair are limited. Osteochondral autograft and allograft reconstruction of these lesions has been used extensively; however, these techniques often require a more invasive surgical exposure, and restoring the natural articular surface radius of curvature can be challenging, particularly in larger lesions. Cell-based repair of these lesions, using autologous chondrocytes in conjunction with bone grafting, has been used with success, although this procedure requires the patient to undergo 2 operations, and access is often restricted due to the high associated costs. Comparable medium-term clinical outcomes have been shown with scaffold-associated mesenchymal stem cell grafting, and this cell-based procedure may also be performed arthroscopically to minimize patient morbidity. In cases of cartilage injury associated with bone loss, this procedure has great potential to repair osteochondral injury when used in conjunction with bone grafting. We present the one-step arthroscopic technique of biologic inlay osteochondral reconstruction in the knee, using an autologous bone graft and a hyaluronic acid-based scaffold embedded with bone marrow aspirate concentrate, to treat full-thickness cartilage lesions associated with significant subchondral bone loss.

Intraosseous Bioplasty for a Chondral Cyst in the Lateral Tibial Plateau

“…Open techniques are preferred because they are time saving and the lesions can be easily assessed. 11 …”

The Use of Peripheral Blood-Derived Stem Cells for Cartilage Repair and Regeneration In Vivo: A Review

“…Moreover, a number of studies have reported concomitant procedures, such as abrasion arthroplasty (Beckmann et al, 2015), autologous bone grafting to restore bone mass (Sadlik et al, 2017), treatment of co-existing pathologies (Wong et al, 2013), and BMS (Jin et al, 2011), PRP (Broeckx et al, 2019a) and HA (Charlesworth et al, 2019) to repair cartilage defects. Thus, the abovementioned methods are recommended to supplement PBSCs for cartilage repair and regeneration.…”

Cartilage Repair in the Knee Using Umbilical Cord Wharton's Jelly–Derived Mesenchymal Stem Cells Embedded Onto Collagen Scaffolding and Implanted Under Dry Arthroscopy

“…Although suture may be used to stabilize the graft during open techniques, fibrin glue has been shown to increase the stability of fixation of type I/III collagen patches, 10 and we have used fibrin glue routinely to secure scaffolds after arthroscopic implantation with excellent results. 7 , 8 …”

“…Recent developments in cell-based cartilage repair techniques that use dry arthroscopic methods have further advanced this field, given the advantages of a minimally invasive technique that reduces morbidity and optimizes postoperative rehabilitation progression. 7 , 8 This Technical Note describes a method of cell-based cartilage repair using allogeneic MSCs sourced from Wharton's jelly (WJ-MSCs) that are embedded onto a type I/III collagen scaffold and implanted under dry arthroscopy ( Video 1 ).…”