Summary

A single stage arthroscopic procedure for the treatment of articular cartilage defects in the knee is described.

Abstract

A single stage arthroscopic procedure for the treatment of articular cartilage defects in the knee is described. This involves microfracture and application of concentrated bone marrow aspirate cells (BMAC) with fibrin gel. The aim of the study was to evaluate the clinical and radiological outcomes at 5 years. The pre-clinical study was performed on rabbits comparing microfracture versus microfracture combined with fibrin gel and concentrated BMAC application. New cartilage from both groups was subjected to staining with hematoxylin-eosin for tissue morphology, toluidine blue for collagen and safranin O for GAG content; immunohistochemistry with antibodies IH11 and CIIC1 for collagen type I and II respectively; and scanning electron microscopy (SEM) and transmission electron microscopy (TEM) to analyze the microstructural morphologies. The fibrin gel-BMAC group scored better than the microfracture group on all counts. This prospective study of 60 patients with symptomatic ICRS grade III/IV chondral defects, ranging from 2-8cm2. Patients underwent morphological MRI, quantitative T2*-mapping and d-GEMRIC scan. Clinical assessment employed the Lysholm, IKDC and KOOS scores while radiological assessment was performed with MOCART score.


At 5 year, Lysholm score improved from 50.8 pre-operatively to 78 (p < 0.05). KOOS improved from 65.7 to 90. IKDC (subjective) improved from 39 to 80. The mean T2* relaxation-times for the repair tissue and native cartilage were 26 and 29.9 respectively. Average MOCART score for all lesions was 70.

Our technique shows encouraging clinical results at 5 year follow-up. The morphological MRI shows good cartilage defect filling and the biochemical MRI (T2*-mapping) suggests hyaline like repair tissue.