title: One-step surgery with multipotent stem cells and Hyaluronan-based scaffold for the treatment of full-thickness chondral defects of the knee in patients older than 45 years.
abstract: OBJECTIVE
  The aim of this study is to prospectively evaluate the medium-term effectiveness and regenerative capability of autologous adult mesenchymal stem cells, harvested as bone marrow aspirate concentrate (BMAC), along with a hyaluronan-based scaffold (Hyalofast) in the treatment of ICRS grade 4 chondral lesions of the knee joint, in patients older than 45 years.
  
  
  METHODS
  A study group of 20 patients with an age >45 years (mean 50.0 ± 4.1 years) was compared to a control group of 20 patients with an age <45 years (mean 36.6 ± 5.0). Patients were prospectively evaluated for 4 years. All patients were evaluated with MRI, KOOS, IKDC, VAS and Tegner scores preoperatively and at two-year and final follow-up.
  
  
  RESULTS
  At final follow-up, all scores significantly improved (P < 0.001) as follows: all KOOS score categories; Tegner 2 (range 0-4) to 6 (range 4-8) and 3 (range 0-6) to 6 (range 3-10); IKDC subjective (39.2 ± 16.5 to 82.2 ± 8.9) and (40.8 ± 13.9 to 79.4 ± 14.6), in the study and control group respectively. In addition, we show that results are affected by lesion size and number but not from concomitant surgical procedures. MRI showed complete filling in 80 % of patients in the study group and 71 % of patients in the control group. Histological analysis conducted in three patients from the study and two patients from the control group revealed good tissue repair with a variable amount of hyaline-like tissue.
  
  
  CONCLUSIONS
  Treatment of cartilage lesions with BMAC and Hyalofast is a viable and effective option that is mainly affected by lesion size and number and not by age. In particular, it allows to address the >45 years population with functional outcomes that are comparable to younger patients at final follow-up.
  
  
  METHODS
  Prospective cohort study, Level II.
authors.affiliation: Orthopaedic Arthroscopic Surgery International (O.A.S.I.) Bioresearch Foundation, Gobbi Onlus, Via GA Amadeo 34, 20133, Milan, Italy. gobbi@cartilagedoctor.it.
authors.forename: Alberto
authors.initials: A
authors.lastname: Gobbi
authors.affiliation: IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
authors.forename: Celeste
authors.initials: C
authors.lastname: Scotti
authors.affiliation: Orthopaedic Arthroscopic Surgery International (O.A.S.I.) Bioresearch Foundation, Gobbi Onlus, Via GA Amadeo 34, 20133, Milan, Italy.
authors.forename: Georgios
authors.initials: G
authors.lastname: Karnatzikos
authors.affiliation: Orthopaedic Arthroscopic Surgery International (O.A.S.I.) Bioresearch Foundation, Gobbi Onlus, Via GA Amadeo 34, 20133, Milan, Italy.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Mudhigere
authors.affiliation: Philippine Orthopeadic Institute, Makati Medical Center, Makati, Philippines.
authors.forename: Marc
authors.initials: M
authors.lastname: Castro
authors.affiliation: IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.|Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
authors.forename: Giuseppe M
authors.initials: GM
authors.lastname: Peretti
mesh_terms: D000328:Adult; D000367:Age Factors; D002357:Cartilage Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D002358:Cartilage, Articular / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use*; D007719:Knee Joint / Q000000981:diagnostic imaging; D008279:Magnetic Resonance Imaging; D008297:Male; D045164:Mesenchymal Stem Cell Transplantation / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D054457:Tissue Scaffolds; D014182:Transplantation, Autologous; D055675:Viscosupplements / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D055675:Viscosupplements; D006820:Hyaluronic Acid
keywords: Bone Marrow Aspirate Concentrate (BMAC); Cartilage; Cartilage lesion; Hyaluronan; Mesenchymal Stem cells (MSCs); Scaffold