One-step bone marrow-derived cell transplantation in talar osteochondral lesions.
The ideal treatment of osteochondral lesions is debatable. Although autologous chondrocyte implantation provides pain relief, the need for two operations and high costs has prompted a search for alternatives. Bone marrow-derived cells may represent the future in osteochondral repair. Using a device to concentrate bone marrow-derived cells and collagen powder or hyaluronic acid membrane as scaffolds for cell support and platelet gel, a one-step arthroscopic technique was developed for cartilage repair. We performed an in vitro preclinical study to verify the capability of bone marrow-derived cells to differentiate into chondrogenic and osteogenic lineages and to be supported onto scaffolds. In a prospective clinical study, we investigated the ability of this technique to repair talar osteochondral lesions in 48 patients. Minimum followup was 24 months (mean, 29 months; range, 24-35 months). Clinical results were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) score and the influence of scaffold type, lesion area, previous surgeries, and lesion depth was considered. MRI and histologic evaluation were performed. The AOFAS score improved from 64.4 +/- 14.5 to 91.4 +/- 7.7. Histologic evaluation showed regenerated tissue in various degrees of remodeling although none showed entirely hyaline cartilage. These data suggest the one-step technique is an alternative for cartilage repair, permitting improved functional scores and overcoming the drawbacks of previous techniques.


METHODS
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Giannini
Sandro
S
VI Department of Orthopaedic and Traumatology, Istituto Ortopedico Rizzoli, University of Bologna, Via GC Pupilli 1, 40136 Bologna, Italy.
Buda
Roberto
R
Vannini
Francesca
F
Cavallo
Marco
M
Grigolo
Brunella
B
D000293:Adolescent; D000328:Adult; D016512:Ankle Injuries / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D001182:Arthroscopy; D016026:Bone Marrow Transplantation; D001861:Bone Regeneration; D002454:Cell Differentiation; D002469:Cell Separation; D002478:Cells, Cultured; D019902:Chondrocytes / Q000378:metabolism / Q000637:transplantation*; D020219:Chondrogenesis; D003094:Collagen / Q000737:chemistry; D005260:Female; D005782:Gels; D006801:Humans; D006820:Hyaluronic Acid / Q000737:chemistry; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010006:Osteoblasts / Q000378:metabolism / Q000637:transplantation*; D055034:Osteochondrosis / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D010012:Osteogenesis; D011446:Prospective Studies; D016059:Range of Motion, Articular; D020127:Recovery of Function; D013628:Talus / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D054457:Tissue Scaffolds; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult
D005782:Gels; D006820:Hyaluronic Acid; D003094:Collagen