Microfracture versus microfracture and platelet-rich plasma: arthroscopic treatment of knee chondral lesions. A two-year follow-up study

Mancò, Annalisa; Goderecci, Remo; Rughetti, Anna; Giorgi, Silvana De; Necozione, Stefano; Bernardi, Alfredo; Calvisi, Vittorio

doi:10.11138/jts/2016.4.3.142

Cited by 29 publications

(32 citation statements)

References 20 publications

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“…While functional and clinical outcomes via the visual analogue pain score, Short Form-36, and International Knee Documentation Committee Subjective Knee Form were not significantly different, they were slightly better in the PRP cohort. 16 A similar study from Zedde et al showed continued improvement in terms of pain symptomology and functional improvement when comparing a group of 30 patients who underwent microfracture followed by a series of 3 PRP injections, compared with a group of 30 whom underwent microfracture alone. 16 As promising results such as these continue to be shown, it is possible that the trend toward increasing numbers of microfracture type cartilage procedures and decrease in the number of palliative procedures will continue.…”

Section: Discussionmentioning

confidence: 87%

“…While studies examining the longterm results of PRP augmented microfracture are limited, early studies show that the addition of PRP is at least as effective as microfracture alone, if not better, with respect to clinical and functional outcome. 16 Mancò et al performed a prospective study of patients aged 52 years, with 13 being treated with microfracture alone, and 14 undergoing microfracture augmented with PRP. While functional and clinical outcomes via the visual analogue pain score, Short Form-36, and International Knee Documentation Committee Subjective Knee Form were not significantly different, they were slightly better in the PRP cohort.…”

Section: Discussionmentioning

confidence: 99%

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Trends in the Surgical Treatment of Articular Cartilage Lesions in the United States from 2007 to 2016

et al. 2020

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Management of cartilage lesions of the knee can be complex, time consuming, and controversial, especially without a widely agreed upon “gold-standard” management. The PearlDiver database (www.pearldiverinc.com, Fort Wayne, IN) was queried for surgical management of cartilage lesions specified by Current Procedure Terminology (CPT) codes: 29877, chondroplasty; 29879, microfracture/drilling; 29866, arthroscopic osteochondral autograft; 29867, arthroscopic osteochondral allograft; 27412, autologous chondrocyte implantation (ACI); 27415, open osteochondral allograft; or 27416, open osteochondral autograft. Procedures were categorized as palliative (chondroplasty), microfracture/drilling, or restorative (arthroscopic osteochondral autograft; arthroscopic osteochondral allograft; ACI; open osteochondral allograft; or open osteochondral autograft). Linear regression was performed to determine the significance of yearly trend across each procedure.From 2007 to 2016, a total of 35,506 surgical procedures were performed. The average yearly incidence was 7.8 per 10,000 patients. Overall, palliative techniques (chondroplasty) were more common (1.8:1 ratio for chondroplasty to microfracture and 34:1 ratio chondroplasty to restoration procedure). There was a trend of decreasing incidence of palliative procedures seen by a significant decrease in the ratio of palliative to microfracture/restorative procedures of 0.2512 each year from 2007 to 2016 (p < 0.001). This decrease followed a linear trend (R 2 = 0.9123). In 2013, the number and incidence of the palliative procedures declined below that of microfracture procedures, with microfracture being most common from 2013 to 2016. Palliative chondroplasty was no longer the most commonly performed procedure for cartilage lesions in the United States from 2007 to 2016, as more surgeons opted for microfracture procedures instead. Restorative procedures (ACI, osteochondral autograft transfer system) remained unchanged over the study period, in accordance with the sports medicine literature; however, early functional outcomes studies do show the equivalency and in some cases superiority compared with microfracture. This is Level III study.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Trends in the Surgical Treatment of Articular Cartilage Lesions in the United States from 2007 to 2016

et al. 2020

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“…Platelet‐rich plasma (PRP) contains a high concentration of growth factors, including transforming growth factor‐β (TGF‐β), insulin‐like growth factor (IGF), platelet‐derived growth factor (PDGF), and vascular endothelial growth factor (VEGF). Since the 1990s, PRP has been widely used in tissue lesions and degenerative disorders . Recent clinical studies have demonstrated that PRP administered by intra‐articular injection can provide symptomatic relief and result in functional improvement in patients with mild to moderate knee OA …”

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confidence: 99%

Intraarticular injection autologous platelet‐rich plasma and bone marrow concentrate in a goat osteoarthritis model

Wang¹,

Zhai

Fei

et al. 2018

Journal Orthopaedic Research

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To evaluate the effects of intraarticular injections of autologous platelet-rich plasma (PRP) or bone marrow concentrate (BMC) on osteoarthritis (OA), 24 adult goats were equally divided into control (Ctrl), saline (NS), PRP, and BMC groups, and OA was induced by surgery in NS, PRP, and BMC groups. Autologous PRP and BMC were obtained from whole blood and bone marrow aspirates, respectively. The data revealed, platelets were increased in BMC by 1.8-fold, monocytes by 5.6-fold, TGF-β1 by 7.7-fold, and IGF-1 by 3.6-fold (p < 0.05), and platelets were increased in PRP by 2.9-fold, and TGF-β1 by 3.3-fold (p < 0.05). From the sixth week post-operation, saline, PRP, and BMC were administered by intraarticular injection once every 4 weeks, three consecutive times. After the animals were sacrificed, inflammatory cytokines in the synovial fluid was measured, and bone and cartilage degeneration progression was observed by macroscopy, histology, and immunohistochemistry. Compared with the NS group, the level of inflammatory cytokines was reduced in the PRP and BMC groups (p < 0.05). Histologically, delayed cartilage degeneration and higher levels of extracellular matrix (ECM) were observed in both PRP and BMC treated groups (p < 0.05). Furthermore, the BMC group showed greater cartilage protection and less ECM loss than the PRP group (p < 0.05). In summary, this study showed that intraarticular injection of autologous PRP and BMC has therapeutic efficacy in a goat osteoarthritis model, with the greater benefit in terms of cartilage protection being observed in the BMC-treated group than PRP. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.

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“…49,[69][70][71][72][73][74][75][76][77][78] MSP can be augmented using cells, biologics, and/or matrices in an attempt to speed and improve defect-tissue fill volume and quality and improve outcomes. 5,15,75,[79][80][81][82][83][84][85] In general, these MSPþ techniques have reported advantages over MSP alone and can be considered for use based on surgeon preference, availability, and cost-effectiveness. The primary limitations associated with MSP and MSPþ techniques involve the size and type of defects that can be effectively treated, the potential sequelae to violation of the subchondral bone plate and dependency on bone marrow-derived cells for repair tissue formation, and the durability of the repair tissue and associated progression of pathology to early-onset knee OA.…”

Section: Marrow Stimulation Proceduresmentioning

confidence: 99%

Clinical Application of the Basic Science of Articular Cartilage Pathology and Treatment

et al. 2020

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The joint is an organ with each tissue playing critical roles in health and disease. Intact articular cartilage is an exquisite tissue that withstands incredible biologic and biomechanical demands in allowing movement and function, which is why hyaline cartilage must be maintained within a very narrow range of biochemical composition and morphologic architecture to meet demands while maintaining health and integrity. Unfortunately, insult, injury, and/or aging can initiate a cascade of events that result in erosion, degradation, and loss of articular cartilage such that joint pain and dysfunction ensue. Importantly, articular cartilage pathology affects the health of the entire joint and therefore should not be considered or addressed in isolation. Treating articular cartilage lesions is challenging because left alone, the tissue is incapable of regeneration or highly functional and durable repair. Nonoperative treatments can alleviate symptoms associated with cartilage pathology but are not curative or lasting. Current surgical treatments range from stimulation of intrinsic repair to whole-surface and whole-joint restoration. Unfortunately, there is a relative paucity of prospective, randomized controlled, or well-designed cohort-based clinical trials with respect to cartilage repair and restoration surgeries, such that there is a gap in knowledge that must be addressed to determine optimal treatment strategies for this ubiquitous problem in orthopedic health care. This review article discusses the basic science rationale and principles that influence pathology, symptoms, treatment algorithms, and outcomes associated with articular cartilage defects in the knee.

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Microfracture versus microfracture and platelet-rich plasma: arthroscopic treatment of knee chondral lesions. A two-year follow-up study

Abstract: Level II, prospective cohort study.

Cited by 29 publications

References 20 publications

Trends in the Surgical Treatment of Articular Cartilage Lesions in the United States from 2007 to 2016

Trends in the Surgical Treatment of Articular Cartilage Lesions in the United States from 2007 to 2016

Intraarticular injection autologous platelet‐rich plasma and bone marrow concentrate in a goat osteoarthritis model

Clinical Application of the Basic Science of Articular Cartilage Pathology and Treatment

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