Morphologic Properties of Cartilage Lesions in the Knee Arthroscopically Prepared by the Standard Curette Technique Are Inferior to Lesions Prepared by Specialized Chondrectomy Instruments

Editorial Commentary: Cartilage Restoration-What Is Currently Available?

In the past 30 years, bone marrow stimulation techniques such as microfracture (MF) have become a popular method to treat symptomatic focal articular cartilage lesions. Nonetheless, recent studies have not shown good long-term clinical outcomes, and MF has produced alterations in the subchondral bone architecture with degenerative changes. Autologous chondrocyte implantation (ACI) has shown good results at 20 years. Second- and third-generation ACI has shown superiority to MF and fewer complications than first-generation ACI. Each treatment option has its advantages and disadvantages. Recent research has shown that better filling of cartilage tissue occurs in patients treated with MF and collagen augmentation than in those treated with MF alone. Research from our clinic has shown that Hyaff scaffold combined with bone marrow aspirate concentrate in a 1-step technique yielded good results in patients with 10 years' follow-up. We believe that high-quality randomized controlled trials are necessary to directly compare all cartilage restoration procedures.

Long-term Clinical Outcomes of One-Stage Cartilage Repair in the Knee With Hyaluronic Acid-Based Scaffold Embedded With Mesenchymal Stem Cells Sourced From Bone Marrow Aspirate Concentrate

BACKGROUND

Cell-based cartilage repair performed as a single-stage procedure is an important advancement in the treatment of full-thickness cartilage injury and has potential for widespread clinical use.

PURPOSE

To investigate the long-term clinical outcomes of cartilage repair in the knee with a hyaluronic acid-based scaffold embedded with bone marrow aspirate concentrate (HA-BMAC) for the treatment of full-thickness cartilage injury.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

Patients underwent treatment of full-thickness chondral injury in the knee with HA-BMAC and were followed prospectively for a minimum of 6 years. Clinical outcomes were examined with patient-reported scoring instruments that consisted of the Tegner Activity Scale, International Knee Documentation Committee (IKDC) subjective score, visual analog scale, and Knee injury and Osteoarthritis Outcome Score (KOOS). Comparative analysis of pre- and postoperative scores was performed, and the effects of patient age, body mass index, lesion size, number of treated lesions, and concurrent treatment with associated procedures were examined.

RESULTS

Twenty-three patients (mean age, 48.5 years) were followed prospectively for a mean 8 years (range, 6-10 years). Median cartilage lesion size was 6.5 cm² (range, 2-27 cm²). At final follow-up, median Tegner, visual analog scale, and IKDC subjective scores were 4, 0.3, and 85, respectively. Final median KOOS subset scores were as follows: Pain, 94; Symptoms, 89; Activities of Daily Living, 99; Sports/Recreation, 85; and Quality of Life, 85. All scores were significantly increased at final follow-up ( P < .001). Comparable median outcome scores were demonstrated after categorization of patients by age, lesion size, treatment of multiple lesions, treatment of multiple knee compartments, and treatment by associated procedures. Rank correlation analysis demonstrated a negative correlation between patient age and final outcome scores of the IKDC, Tegner, and KOOS subsets of Pain, Activities of Daily Living, and Sports/Recreation. No associations were identified between body mass index or lesion size and outcome scores.

CONCLUSION

Repair of full-thickness cartilage injury in the knee with a HA-BMAC provides good to excellent clinical outcomes at long-term follow-up in the treatment of small to large lesions. Cartilage repair with HA-BMAC leads to comparatively successful long-term outcomes in the treatment of small or large lesions, single or multiple lesions, and lesions in 1 or 2 compartments, as well as in cases of associated lesion treatment. While good outcomes can be expected among treated patients >45 years of age, outcomes may be comparatively more successful in younger patients.

Editorial Commentary: Acetabular Cartilage Repair: A Critically Important Frontier in Hip Preservation

Articular cartilage damage to the acetabulum is frequently associated with femoroacetabular impingement, and there are considerable long-term implications for such injury with regard to maintenance of a healthy hip joint and quality of life. Developing treatments capable of restoring articular cartilage to acetabular cartilage defects is of great importance if hip preservation treatments are to be successful. Ideally, such methods should be performed in a minimally invasive manner and be capable of restoring durable repair tissue that reconstitutes a healthy osteochondral unit and that continues to function effectively over the long term.

Editorial Commentary: Can We Really See the Calcified Cartilage Layer When Debriding Focal Cartilage Defects?

Cell-based cartilage restoration techniques have made huge leaps in recent years; however, many hurdles still lay ahead, one of which is the fundamental task of preparing the cartilage lesion site. Although it is one of the first skills an arthroscopist learns during training, it seems that current techniques and instrumentation still yield inconsistent results, which can hinder patient outcomes.