One-step surgery with multipotent stem cells for the treatment of large full-thickness chondral defects of the knee.
BACKGROUND
Chondral lesions in athletically active patients cause considerable morbidity, and treatment with existing cell-based therapies can be challenging. Bone marrow has been shown as a possible source of multipotent stem cells (MSCs) with chondrogenic potential and is easy to harvest during the same surgical procedure.


OBJECTIVE
To investigate the clinical outcome in a group of active patients with large full-thickness chondral defects of the knee treated with 1-step surgery using bone marrow-derived MSCs and a second-generation matrix.


METHODS
Case series; Level of evidence, 4.


METHODS
From January 2007 to February 2010, 25 patients (average age, 46.5 years) with symptomatic large chondral defects of the knee (International Cartilage Repair Society grade 4) who underwent cartilage transplantation with MSCs and a collagen type I/III matrix were followed up for a minimum of 3 years. The average lesion size was 8.3 cm(2). Coexisting injuries were treated during the same surgical procedure in 18 patients. All patients underwent a standard postoperative rehabilitation program. Preoperative and postoperative evaluations at 1-year, 2-year, and final follow-up included radiographs, magnetic resonance imaging (MRI), and visual analog scale (VAS) for pain, International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm, Marx, and Tegner scores. Seven patients underwent second-look arthroscopic surgery, with 4 consenting to a tissue biopsy.


RESULTS
No patients were lost at final follow-up. The average preoperative values for the evaluated scores were significantly improved at final follow-up (P < .001): VAS, 5.4 ± 0.37 to 0.48 ± 0.19; IKDC subjective, 37.92 ± 4.52 to 81.73 ± 2.42; KOOS pain, 61.04 ± 3.95 to 93.32 ± 1.92; KOOS symptoms, 55.64 ± 3.23 to 89.32 ± 2.32; KOOS activities of daily living, 63.96 ± 4.48 to 91.20 ± 2.74; KOOS sports, 34.20 ± 5.04 to 80.00 ± 3.92; KOOS quality of life, 32.20 ± 4.43 to 83.04 ± 3.37; Lysholm, 46.36 ± 2.25 to 86.52 ± 2.73; Marx, 3.00 ± 0.79 to 9.04 ± 0.79; and Tegner, 2.12 ± 0.32 to 5.64 ± 0.26. Patients younger than 45 years of age and those with smaller or single lesions showed better outcomes. The MRI scans showed good stability of the implant and complete filling of the defect in 80% of patients, and hyaline-like cartilage was found in the histological analysis of the biopsied tissue. No adverse reactions or postoperative complications were noted.


CONCLUSIONS
The treatment of large chondral defects with MSCs is an effective procedure and can be performed routinely in clinical practice. Moreover, it can be achieved with 1-step surgery, avoiding a previous surgical procedure to harvest cartilage and subsequent chondrocyte cultivation.
Alberto Gobbi, Orthopaedic Arthroscopic Surgery International (OASIBioresearch Foundation, G.A. Amadeo 24, 20133 Milan, Italy. gobbi@cartilagedoctor.it).
Alberto
A
Gobbi
Georgios
G
Karnatzikos
Sukesh Rao
SR
Sankineani
D000328:Adult; D001182:Arthroscopy; D002356:Cartilage / Q000637:transplantation*; D002358:Cartilage, Articular / Q000293:injuries*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007430:Intraoperative Care; D007719:Knee Joint / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D039902:Multipotent Stem Cells / Q000637:transplantation*; D019637:Orthopedic Procedures / Q000379:methods; D063868:Patient Outcome Assessment; D011446:Prospective Studies; D016059:Range of Motion, Articular; D024162:Second-Look Surgery; D054457:Tissue Scaffolds; D020858:Tissue and Organ Harvesting / Q000379:methods; D014182:Transplantation, Autologous; D064232:Visual Analog Scale
BMAC; MSCs; cartilage; chondral defects; collagen I/III matrix