Treatment of cartilage injuries using combined BMAC and PRP resulted in improvements in subjective outcome and MOCART scores one year postoperative, which were non-significant after two years.
Cell-based cartilage repair treatments are limited due to high costs of cell expansion prior to implantation. The use of autologous bone marrow aspirate concentrate (BMAC) has been proposed as an alternative one-step strategy. Platelet-rich plasma (PRP) is an increasingly popular endogenous source of concentrated growth factors.
To evaluate the clinical use of combined BMAC and PRP on a collagen I/III scaffold for treating cartilage lesions in the knee.
Material And Methods
Ten patients (Mean age: 29.4 years, range 18-36) suffering from large full-thickness cartilage lesions on patella (n=7) or the femoral condyles (n=3) were treated with BMAC and PRP from January 2015 to December 2016. Bone marrow was aspirated from the iliac crest and was prepared using centrifugation to yield BMAC. PRP was prepared using whole blood. BMAC and PRP was then seeded onto a collagen I/III scaffold and sutured into the debrided defect.
Patients were evaluated by clinical outcome scores (IKDC, KOOS and NRS) pre-operatively, after three months, one and two years and through MRI after one year, evaluated using “magnetic resonance observation of cartilage repair tissue” (MOCART) score (0(worst) - 100(best)).
After one year statistically significant improvements were found in IKDC (35.5 to 58.4, p = 0.003), NRS activity (7.3 to 4.9, p = 0.006), KOOS symptoms (60.5 to 77.5, p = 0.01), KOOS ADL (64.3 to 78.4, p = 0.04) and KOOS QOL (23.2 to 41.9, p = 0.04). MOCART was 36.5 (30.3-42.7) after one year.
At two years follow-up statistically significant improvements were seen in IKDC (35.5 to 54.6, p = 0.009), NRS rest (3.3 to 1.7, p = 0.02) and NRS activity (7.3 to 5.1, p = 0.007).
Treatment of cartilage injuries using combined BMAC and PRP resulted in improvements in subjective outcome scores one and two years postoperatively.