Failure of Bone Marrow Stimulation Techniques

Frank, Rachel M.; Cotter, Eric J.; Nassar, Islam; Cole, Brian J.

doi:10.1097/jsa.0000000000000134

Cited by 40 publications

(21 citation statements)

References 61 publications

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“…Focal cartilage defects of the knee are commonly treated with marrow stimulation techniques, which have been shown to have inferior long-term clinical outcomes due in large part to the predominantly fibrocartilage repair tissue generated. [5][6][7] Fibrocartilage has poor compressive stiffness under load, inferior resilience and inferior wear characteristics than hyaline cartilage. 8 Recently, bone marrow aspirate concentrate (BMAC) has been investigated as both a primary therapeutic as well as an augmentation to existing cartilage restoration procedures.…”

Section: Introductionmentioning

confidence: 99%

Bone Marrow Aspirate Concentrate for Cartilage Defects of the Knee: From Bench to Bedside Evidence

et al. 2017

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Objective To critically evaluate the current basic science, translational, and clinical data regarding bone marrow aspirate concentrate (BMAC) in the setting of focal cartilage defects of the knee and describe clinical indications and future research questions surrounding the clinical utility of BMAC for treatment of these lesions. Design A literature search was performed using the PubMed and Ovid MEDLINE databases for studies in English (1980-2017) using keywords, including ["bone marrow aspirate" and "cartilage"], ["mesenchymal stem cells" and "cartilage"], and ["bone marrow aspirate" and "mesenchymal stem cells" and "orthopedics"]. A total of 1832 articles were reviewed by 2 independent authors and additional literature found through scanning references of cited articles. Results BMAC has demonstrated promising results in the clinical application for repair of chondral defects as an adjuvant procedure or as an independent management technique. A subcomponent of BMAC, bone marrow derived-mesenchymal stem cells (MSCs) possess the ability to differentiate into cells important for osteogenesis and chondrogenesis. Modulation of paracrine signaling is perhaps the most important function of BM-MSCs in this setting. In an effort to increase the cellular yield, authors have shown the ability to expand BM-MSCs in culture while maintaining phenotype. Conclusions Translational studies have demonstrated good clinical efficacy of BMAC both concomitant with cartilage restoration procedures, at defined time points after surgery, and as isolated injections. Early clinical data suggests BMAC may help stimulate a more robust hyaline cartilage repair tissue response. Numerous questions remain regarding BMAC usage, including cell source, cell expansion, optimal pathology, and injection timing and quantity.

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Section: Introductionmentioning

confidence: 99%

Bone Marrow Aspirate Concentrate for Cartilage Defects of the Knee: From Bench to Bedside Evidence

et al. 2017

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“…13,24 Recent reviews have raised concerns about the long-term durability of microfracture in other joints, and it is important to characterize these outcomes for the glenohumeral joint. 7,[13][14][15] Long-term outcomes after microfracture of the glenohumeral joint are unclear. The purpose of this study is to provide updated long-term clinical follow-up on a previously reported cohort of patients who underwent microfracture for symptomatic articular cartilage defects of the glenohumeral joint.…”

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confidence: 99%

Long-term Clinical Outcomes After Microfracture of the Glenohumeral Joint: Average 10-Year Follow-up

Wang

Frank²,

Cotter

et al. 2018

Am J Sports Med

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Treating full-thickness symptomatic chondral defects of the glenohumeral joint with microfracture can result in long-term improved function and reduced pain for some patients. However, in this case series, 21.4% of patients required conversion to arthroplasty <10 years after the index microfracture procedure, and 33% to 42% of patients were considered to have potential clinical failure. Additional studies with larger patient cohorts are needed.

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“…Focal chondral defects (FCDs) of the knee joint are common, occurring in over 60% of patients undergoing knee arthroscopic surgery. 1,7,9,13,18,26 FCDs have limited regenerative potential in response to injuries, as articular cartilage is relatively avascular and aneural. 12,13,26 Untreated FCDs within the knee joint can result in mechanical symptoms that impair function or cause pain and effusion, especially when located on weightbearing surfaces of the medial or lateral compartments.…”

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confidence: 99%

“…1,7,9,13,18,26 FCDs have limited regenerative potential in response to injuries, as articular cartilage is relatively avascular and aneural. 12,13,26 Untreated FCDs within the knee joint can result in mechanical symptoms that impair function or cause pain and effusion, especially when located on weightbearing surfaces of the medial or lateral compartments. 13 In contrast, osteoarthritis (OA) of the knee joint is characterized by progressive loss of articular cartilage, osteophytes, subchondral cysts, joint space narrowing, and intermittent inflammation of the joint tissues.…”

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confidence: 99%

Do Focal Chondral Defects of the Knee Increase the Risk for Progression to Osteoarthritis? A Review of the Literature

Houck

Kraeutler

Belk

et al. 2018

Orthopaedic Journal of Sports Medicine

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Background:Focal chondral defects (FCDs) of the knee are believed to contribute to the development of osteoarthritis (OA), resulting in pain and dysfunction.Purpose:To investigate whether untreated FCDs of the knee progress to radiographically evident OA over time.Study Design:Systematic review; Level of evidence, 3.Methods:A literature review was performed by searching the PubMed, Embase, and Cochrane Library databases to locate studies evaluating clinical and/or radiological outcomes of patients with FCDs that were diagnosed by arthroscopic surgery or magnetic resonance imaging (MRI) and were left untreated with a minimum 2-year follow-up. Additionally, studies were included if there was a radiographic assessment of OA. Search terms used were “knee,” “focal,” “isolated,” “chondral,” “cartilage,” and “osteoarthritis.” Studies were evaluated based on clinical/radiological outcomes and OA risk factors. The study methodology was assessed using the modified Coleman Methodology Score.Results:Eight studies comprising 1425 knees met the inclusion criteria. All studies were of level 3 evidence. The risk of incident cartilage damage (enlargement of original FCDs or incidence of additional FCDs) at latest follow-up was assessed in 3 studies, while 1 study only reported the incidence of cartilage damage at follow-up. All 4 studies noted an increased progression of cartilage damage at follow-up. The progression of cartilage damage was most commonly seen in the patellofemoral joint and medial femoral condyle but was not associated with the development of knee OA based on the Kellgren-Lawrence grade. MRI of the FCDs revealed increased water content, cartilage deterioration, and proteoglycan loss within the medial and lateral compartments.Conclusion:Patients with untreated FCDs of the knee joint are more likely to experience a progression of cartilage damage, although the studies included in this review did not demonstrate the development of radiographically evident OA within 2 years of follow-up.

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Failure of Bone Marrow Stimulation Techniques

Cited by 40 publications

References 61 publications

Bone Marrow Aspirate Concentrate for Cartilage Defects of the Knee: From Bench to Bedside Evidence

Bone Marrow Aspirate Concentrate for Cartilage Defects of the Knee: From Bench to Bedside Evidence

Long-term Clinical Outcomes After Microfracture of the Glenohumeral Joint: Average 10-Year Follow-up

Do Focal Chondral Defects of the Knee Increase the Risk for Progression to Osteoarthritis? A Review of the Literature

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