title: Bone Marrow Concentrate Improves Early Cartilage Phase Maturation of a Scaffold Plug in the Knee: A Comparative Magnetic Resonance Imaging Analysis to Platelet-Rich Plasma and Control.
abstract: BACKGROUND
  Limited information exists on the clinical use of a synthetic osteochondral scaffold plug for cartilage restoration in the knee.
  
  
  OBJECTIVE
  The purpose of this study was to compare the early magnetic resonance imaging (MRI) appearance, including quantitative T2 values, between cartilage defects treated with a scaffold versus a scaffold with platelet-rich plasma (PRP) or bone marrow aspirate concentrate (BMAC). The hypothesis was that the addition of PRP or BMAC would result in an improved cartilage appearance.
  
  
  METHODS
  Cohort study; Level of evidence, 3.
  
  
  METHODS
  Forty-six patients with full-thickness cartilage defects of the femur were surgically treated with a control scaffold (n = 11), scaffold with PRP (n = 23), or scaffold with BMAC (n = 12) and were followed prospectively. Patients underwent MRI with a qualitative assessment and quantitative T2 mapping at 12 months after surgery. An image assessment was performed retrospectively by a blinded musculoskeletal radiologist. The cartilage phase was measured by cartilage fill and quantitative T2 values on MRI. A comparison between groups after cartilage repair was performed.
  
  
  RESULTS
  The control scaffold group consisted of 8 male and 3 female patients (mean age, 38 years; mean body mass index [BMI], 25 kg/m(2)), the PRP group had 15 male and 8 female patients (mean age, 39 years; mean BMI, 26 kg/m(2)), and the BMAC group consisted of 8 male and 4 female patients (mean age, 36 years; mean BMI, 26 kg/m(2)). The PRP-treated (P = .002) and BMAC-treated (P = .03) scaffolds had superior cartilage fill compared with the control group. With quantitative methods, the PRP group demonstrated a mean T2 value (49.1 ms) that was similar to that of the control scaffold group (42.7 ms; P = .07), but the BMAC group demonstrated a mean T2 value (60.5 ms) closer to that of superficial hyaline cartilage (P = .01). The stratification of T2 values between the deep and superficial zones was not observed in any of the groups.
  
  
  CONCLUSIONS
  In this comparative study, patients treated with scaffold implantation augmented with BMAC had improved cartilage maturation with greater fill and mean T2 values closer to that of superficial native hyaline cartilage at 12 months. Further work will determine if this translates into improved clinical outcomes.
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA krych.aaron@mayo.edu.
authors.forename: Aaron J
authors.initials: AJ
authors.lastname: Krych
authors.affiliation: Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA.
authors.forename: Danyal H
authors.initials: DH
authors.lastname: Nawabi
authors.affiliation: Institute of Diagnostic and Interventional Radiology, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Nadja A
authors.initials: NA
authors.lastname: Farshad-Amacker
authors.affiliation: Division of Sports Medicine and Shoulder Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA.
authors.forename: Kristofer J
authors.initials: KJ
authors.lastname: Jones
authors.affiliation: University of Utah Orthopaedic Center, Salt Lake City, Utah, USA.
authors.forename: Travis G
authors.initials: TG
authors.lastname: Maak
authors.affiliation: Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA.
authors.forename: Hollis G
authors.initials: HG
authors.lastname: Potter
authors.affiliation: Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA.
authors.forename: Riley J
authors.initials: RJ
authors.lastname: Williams
mesh_terms: D000328:Adult; D016026:Bone Marrow Transplantation; D002357:Cartilage Diseases / Q000601:surgery*; D016022:Case-Control Studies; D020219:Chondrogenesis / Q000502:physiology; D015331:Cohort Studies; D005260:Female; D005269:Femur; D006801:Humans; D051457:Hyaline Cartilage / Q000502:physiology; D007719:Knee Joint / Q000601:surgery*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D053657:Platelet-Rich Plasma; D054457:Tissue Scaffolds; D055815:Young Adult
keywords: BMAC; MRI; PRP; plug; scaffold