Repair Potential of Matrix-Induced Bone Marrow Aspirate Concentrate and Matrix-Induced Autologous Chondrocyte Implantation for Talar Osteochondral Repair

Abstract

Objective. The low regenerative potential of cartilage contributed to the development of different cell therapies aimed to improve the clinical outcome in young patients with Osteochondral Lesions of the Talus (OLT). This study is designed to assess the regenerative potential of autologous matrix-induced Bone Marrow Aspirate Concentrate (mBMAC) and matrix-induced Autologous Chondrocyte Implantation (mACI) evaluating, on a small number of osteochondral biopsies, the expression of some catabolic, inflammatory, and pain mediators. Design. Twenty-two patients with OLT were analyzed in this study; 7 were treated with mACI and 15 with mBMAC. Informed consent was obtained from all the patients. Clinical assessments were performed pre-operatively and at 12, 24, and 36 months after surgery using the American Orthopedic Foot and Ankle Society (AOFAS). Histology and immunohistochemistry were used to assess cartilage repair at 24 months. Data were analyzed using non-parametric Wilcoxon-Mann-Whitney and Spearman tests. Results. A remarkable improvement in AOFAS score was noticed for both treatments up to 36 months; however, patients treated with mACI reported the best AOFAS score. Various degrees of tissue remodeling were observed by histological analysis for both cell strategies. However, mBMAC treatment showed a higher expression of some fibrous and hypertrophic markers compared to mACI group. A mild positivity for nerve growth factor, as pain mediator, was noticed for both treatments. Conclusions. Our findings demonstrated the best histological and clinical results following mACI treatment since different fibrotic and hypertrophic features were evident in the mBMAC group at 24-month follow-up.

Scaffold-Based Therapies: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle

“…41 In earlier studies, chondrocytes harvested for ACI/MACI for osteochondral lesions of the talus were derived from nonweightbearing regions of the ipsilateral knee. 10,16,26,32 Although McCarthy et al 31 found no significant joint morbidity at the chondral harvest site in the knee, concern for possible iatrogenic harm increased the use of cartilage harvested from the anterior (ventral) aspect of the talus 3,6,33 or the lesion itself, including excised fragments or lesion margins, 1,3,5,7,14,21,22,24 with Kreulen et al 24 reporting that chondrocytes harvested from the damaged articular surface of 151 patients had an average cell viability of 92%. In one study comparing chondrocyte sources, Giannini et al 19 found similar functional improvement when performing ACI with chondrocytes derived from the ipsilateral knee or the detached osteochondral fragment.…”

“…Furthermore, it is increasingly appreciated that research findings in the knee should not be extrapolated to the ankle, given the differences in structure, molecular composition, response to trauma, susceptibility to osteoarthritis, and response to treatments, that exist between joints. 13 Scaffolds for scaffold-based therapies have included periosteum, 6,14,18 hyaluronan-based membranes (eg, Hyaff, Hyalograft), 5,7,8,14 collagen powder, 8,20 collagen I membrane, 3 collagen I/III membrane (eg, ChondroGide), 1,22,25,38 collagen gel, 37,39 and fibrin gel. 27,28 To the best of our knowledge, no study has prospectively compared scaffold types in association with these procedures.…”

Effects of bone marrow aspirate concentrate and platelet-rich plasma on patients with partial tear of the rotator cuff tendon

“…We believe that one of the mechanisms for this pain reduction is downregulation of inflammatory mediators by PRP [ 32 , 33 ] and BMAC [ 34 ]. We do not know whether PRP or BMAC has a greater impact on pain reduction; both may have played a role in reducing pain in our study.…”

<p>Development and Prospect of Intra-Articular Injection in the Treatment of Osteoarthritis: A Review</p>

“…The long-term therapeutic effect is still non-ideal after a period of time. 12 Autologous chondrocyte implantation (ACI) is suitable for large osteochondral defects left after the failure of the first treatment. But this method is time-consuming, expensive, and the clinical effect is not accurate.…”