title: Articular cartilage repair using marrow stimulation augmented with a viable chondral allograft: 9-month postoperative histological evaluation.
abstract: Marrow stimulation is frequently employed to treat focal chondral defects of the knee. However, marrow stimulation typically results in fibrocartilage repair tissue rather than healthy hyaline cartilage, which, over time, predisposes the repair to failure. Recently, a cryopreserved viable chondral allograft was developed to augment marrow stimulation. The chondral allograft is comprised of native viable chondrocytes, chondrogenic growth factors, and extracellular matrix proteins within the superficial, transitional, and radial zones of hyaline cartilage. Therefore, host mesenchymal stem cells that infiltrate the graft from the underlying bone marrow following marrow stimulation are provided with the optimal microenvironment to undergo chondrogenesis. The present report describes treatment of a trochlear defect with marrow stimulation augmented with this novel chondral allograft, along with nine month postoperative histological results. At nine months, the patient demonstrated complete resolution of pain and improvement in function, and the repair tissue consisted of 85% hyaline cartilage. For comparison, a biopsy obtained from a patient 8.2 months after treatment with marrow stimulation alone contained only 5% hyaline cartilage. These outcomes suggest that augmenting marrow stimulation with the viable chondral allograft can eliminate pain and improve outcomes, compared with marrow stimulation alone.
authors: Department of Orthopedics, Coordinated Health, 2775 Schoenersville Road, Bethlehem, PA 18017, USA.
authors: James K
authors: JK
authors: Hoffman
authors: Product Development Department, Osiris Therapeutics, 7015 Einstein Drive, Columbia, MD 21046, USA.
authors: Sandra
authors: S
authors: Geraghty
authors: Clinical Education and Research Department, Coordinated Health, 3435 Winchester Road, Allentown, PA 18104, USA.
authors: Nicole M
authors: NM
authors: Protzman
references: Knee Surg Sports Traumatol Arthrosc. 2005 Apr;13(3):213-21
references: 15146311
references: Osteoarthritis Cartilage. 2002 Jun;10(6):432-63
references: 12056848
references: Knee Surg Sports Traumatol Arthrosc. 2010 Nov;18(11):1456-64
references: 20127072
references: Arthroscopy. 1997 Aug;13(4):456-60
references: 9276052
references: Knee Surg Sports Traumatol Arthrosc. 2013 Aug;21(8):1770-6
references: 22572868
references: J Bone Joint Surg Am. 2006 Jun;88(6):1374-84
references: 16764096
references: Vet Surg. 1999 Jul-Aug;28(4):242-55
references: 10424704
references: Knee Surg Sports Traumatol Arthrosc. 2009 Sep;17(9):1135-9
references: 19296083
references: Osteoarthritis Cartilage. 2006 Nov;14(11):1119-25
references: 16815714
references: Arthroscopy. 2005 Sep;21(9):1066-75
references: 16171631
references: Coll Antropol. 2009 Jun;33(2):619-23
references: 19662788
references: Nat Mater. 2007 May;6(5):385-92
references: 17435762
references: Am J Sports Med. 2011 Dec;39(12 ):2566-74
references: 21908720
references: Arthroscopy. 2006 Nov;22(11):1180-6
references: 17084294
references: Osteoarthritis Cartilage. 2005 Aug;13(8):655-64
references: 15905106
references: Am J Sports Med. 1998 Nov-Dec;26(6):853-61
references: 9850792
references: Cartilage. 2010 Apr;1(2):145-52
references: 26069546
references: Clin Orthop Relat Res. 2003 Feb;(407):215-27
references: 12567150
references: J Orthop Res. 2000 Sep;18(5):781-9
references: 11117301
references: Am J Sports Med. 2009 Oct;37(10):2053-63
references: 19251676
references: Rheum Dis Clin North Am. 1993 Aug;19(3):725-39
references: 8210584
references: Osteoarthritis Cartilage. 2006 Nov;14(11):1126-35
references: 16765606
references: J Bone Joint Surg Am. 1993 Apr;75(4):532-53
references: 8478382
references: Biotechnol Lett. 2008 Mar;30(3):435-9
references: 17973085
references: J Bone Joint Surg Am. 2010 Apr;92(4):994-1009
references: 20360528
references: Am J Sports Med. 2010 May;38(5):880-90
references: 20203290
references: Arthroscopy. 2002 Sep;18(7):730-4
references: 12209430
references: J Bone Joint Surg Am. 1980 Jan;62(1):79-89
references: 7351420
references: Arthritis Rheum. 2006 Feb;54(2):433-42
references: 16447218
references: Arthroscopy. 2007 Sep;23(9):948-55
references: 17868833
references: J Bone Joint Surg Am. 2005 Dec;87(12):2671-86
references: 16322617
references: Biomaterials. 2005 Jun;26(17):3617-29
references: 15621252
references: Open Orthop J. 2013 May 03;7:133-43
references: 23730377
references: J Orthop Res. 2009 Oct;27(10):1353-60
references: 19382184
references: Clin Orthop Relat Res. 2007 Sep;462:221-8
references: 17534189
references: Am J Sports Med. 2009 Apr;37(4):720-6
references: 19204370
references: Clin Orthop Relat Res. 2001 Oct;(391 Suppl):S362-9
references: 11603719
references: Tissue Eng Part B Rev. 2010 Jun;16(3):305-29
references: 20025455
references: Am J Sports Med. 2008 Feb;36(2):235-46
references: 18202295
references: Curr Rev Musculoskelet Med. 2012 Sep;5(3):229-35
references: 22628178
references: Am J Sports Med. 2006 Sep;34(9):1413-8
references: 16735588