Autologous bone-marrow mesenchymal cell induced chondrogenesis: Single-stage arthroscopic cartilage repair

We describe a single stage arthroscopic procedure for the treatment of articular cartilage defects in the knee. The novel procedure involves microfracture and application of bone marrow aspirate concentrate cells (BMAC) with hyaluronic acid and fibrin gel. The aim of the study was to evaluate the clinical and radiological outcomes at 2 years. A prospective study of 30 patients with symptomatic ICRS grade III/IV chondral defects, ranging from 2-9 cm², who were assessed clinically and radiologically. The surgical procedure involved debridement of the lesion, microfracture and application of concentrated BMAC with HA and fibrin gel under CO₂ insufflation. Patients underwent morphological MRI, quantitative T2-mapping and d-GEMRIC scan. Clinical assessment used the Lysholm, IKDC and KOOS scores. Radiological assessment used the MOCART score. At 2 year follow-up, Lysholm score was 80.1, as compared to 50.8 pre-operatively (p < 0.05). KOOS (symptomatic) was 92.1, as compared to 65.7 pre-operatively. IKDC (subjective) was 83, up from 39 preoperatively. The mean T2relaxation-times for the repair tissue and native cartilage were 29.1 and 29.9 respectively. Average MOCART score for all lesions was 72. Our technique shows encouraging clinical results at 2 year follow-up. Clinical outcome scores show significant benefit. The morphological MRI shows good cartilage defect filling and the biochemical MRI (T2-mapping) suggests hyaline like repair tissue.