scholarly journals A Novel Bone Marrow Stimulation Technique Augmented by Administration of Ultrapurified Alginate Gel Enhances Osteochondral Repair in a Rabbit Model

2015 ◽  
Vol 21 (12) ◽  
pp. 1263-1273 ◽  
Author(s):  
Rikiya Baba ◽  
Tomohiro Onodera ◽  
Daisuke Momma ◽  
Masatake Matsuoka ◽  
Kazutoshi Hontani ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Rabbit Model ◽  
Bone Marrow Stimulation ◽  
Alginate Gel ◽  
Marrow Stimulation ◽  
Osteochondral Repair ◽  
Stimulation Technique

Bone Marrow Stimulation Technique Augmented by an Ultrapurified Alginate Gel Enhances Cartilage Repair in a Canine Model

2018 ◽  
Vol 46 (8) ◽  
pp. 1970-1979 ◽  
Author(s):  
Rikiya Baba ◽  
Tomohiro Onodera ◽  
Masatake Matsuoka ◽  
Kazutoshi Hontani ◽  
Zenta Joutoku ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Cartilage Repair ◽  
Treatment Strategies ◽  
Cartilage Lesion ◽  
Control Group ◽  
Micro Computed Tomography ◽  
Bone Marrow Stimulation ◽  
Marrow Stimulation ◽  
Stimulation Technique ◽  
Better Than

Background: The optimal treatment for a medium- or large-sized cartilage lesion is still controversial. Since an ultrapurified alginate (UPAL) gel enhances cartilage repair in animal models, this material is expected to improve the efficacy of the current treatment strategies for cartilage lesions. Hypothesis: The bone marrow stimulation technique (BMST) augmented by UPAL gel can induce hyaline-like cartilage repair. Study Design: Controlled laboratory study. Methods: Two cylindrical osteochondral defects were created in the patellar groove of 27 beagle dogs. A total of 108 defects were divided into 3 groups: defects without intervention (control group), defects with the BMST (microfracture group), and defects with the BMST augmented by implantation of UPAL gel (combined group). At 27 weeks postoperatively, macroscopic and histological evaluations, micro–computed tomography assessment, and mechanical testing were performed for each reparative tissue. Results: The defects in the combined group were almost fully covered with translucent reparative tissues, which consisted of hyaline-like cartilage with well-organized collagen structures. The macroscopic score was significantly better in the combined group than in the control group ( P < .05). The histological scores in the combined group were significantly better than those in the control group ( P < .01) and microfracture group ( P < .05). Although the repaired subchondral bone volumes were not influenced by UPAL gel augmentation, the mechanical properties of the combined group were significantly better than those of the microfracture group ( P < .05). Conclusion: The BMST augmented by UPAL gel elicited hyaline-like cartilage repair that had characteristics of rich glycosaminoglycan and matrix immunostained by type II collagen antibody in a canine osteochondral defect model. The present results suggest that the current technique has the potential to be one of the autologous matrix-induced chondrogenesis techniques of the future and to expand the operative indications for the BMST without loss of its technical simplicity. Clinical Relevance: The data support the clinical reality of 1-step minimally invasive cartilage-reparative medicine with UPAL gel without harvesting donor cells.

scholarly journals Satisfactory long-term clinical outcomes after bone marrow stimulation of osteochondral lesions of the talus

2021 ◽  
Author(s):  
Quinten G. H. Rikken ◽  
Jari Dahmen ◽  
Sjoerd A. S. Stufkens ◽  
Gino M. M. J. Kerkhoffs
Keyword(s):  
Bone Marrow ◽  
Clinical Outcomes ◽  
Degenerative Changes ◽  
Osteochondral Lesions ◽  
Ankle Osteoarthritis ◽  
Bone Marrow Stimulation ◽  
Marrow Stimulation ◽  
The Mean

Abstract Purpose The purpose of the present study was to evaluate the clinical and radiological outcomes of arthroscopic bone marrow stimulation (BMS) for the treatment of osteochondral lesions of the talus (OLTs) at long-term follow-up. Methods A literature search was conducted from the earliest record until March 2021 to identify studies published using the PubMed, EMBASE (Ovid), and Cochrane Library databases. Clinical studies reporting on arthroscopic BMS for OLTs at a minimum of 8-year follow-up were included. The review was performed according to the PRISMA guidelines. Two authors independently conducted the article selection and conducted the quality assessment using the Methodological index for Non-randomized Studies (MINORS). The primary outcome was defined as clinical outcomes consisting of pain scores and patient-reported outcome measures. Secondary outcomes concerned the return to sport rate, reoperation rate, complication rate, and the rate of progression of degenerative changes within the tibiotalar joint as a measure of ankle osteoarthritis. Associated 95% confidence intervals (95% CI) were calculated based on the primary and secondary outcome measures. Results Six studies with a total of 323 ankles (310 patients) were included at a mean pooled follow-up of 13.0 (9.5–13.9) years. The mean MINORS score of the included studies was 7.7 out of 16 points (range 6–9), indicating a low to moderate quality. The mean postoperative pooled American Orthopaedic Foot and Ankle Society (AOFAS) score was 83.8 (95% CI 83.6–84.1). 78% (95% CI 69.5–86.8) participated in sports (at any level) at final follow-up. Return to preinjury level of sports was not reported. Reoperations were performed in 6.9% (95% CI 4.1–9.7) of ankles and complications related to the BMS procedure were observed in 2% (95% CI 0.4–3.0) of ankles. Progression of degenerative changes was observed in 28% (95% CI 22.3–33.2) of ankles. Conclusion Long-term clinical outcomes following arthroscopic BMS can be considered satisfactory even though one in three patients show progression of degenerative changes from a radiological perspective. These findings indicate that OLTs treated with BMS may be at risk of progressing towards end-stage ankle osteoarthritis over time in light of the incremental cartilage damage cascade. The findings of this study can aid clinicians and patients with the shared decision-making process when considering the long-term outcomes of BMS. Level of evidence Level IV.

scholarly journals Intralesional Osteophyte Regrowth Following Autologous Chondrocyte Implantation after Previous Treatment with Marrow Stimulation Technique

Cartilage ◽  
2016 ◽  
Vol 8 (2) ◽  
pp. 131-138 ◽  
Author(s):  
Marco Kawamura Demange ◽  
Tom Minas ◽  
Arvind von Keudell ◽  
Sonal Sodha ◽  
Tim Bryant ◽  
...  
Keyword(s):  
Autologous Chondrocyte Implantation ◽  
Previous Treatment ◽  
Control Group ◽  
Collagen Membrane ◽  
Bone Marrow Stimulation ◽  
Marrow Stimulation ◽  
Chondrocyte Implantation ◽  
And Control ◽  
Stimulation Technique ◽  
Autologous Chondrocyte

Objective Bone marrow stimulation surgeries are frequent in the treatment of cartilage lesions. Autologous chondrocyte implantation (ACI) may be performed after failed microfracture surgery. Alterations to subchondral bone as intralesional osteophytes are commonly seen after previous microfracture and removed during ACI. There have been no reports on potential recurrence. Our purpose was to evaluate the incidence of intralesional osteophyte development in 2 cohorts: existing intralesional osteophytes and without intralesional osteophytes at the time of ACI. Study Design We identified 87 patients (157 lesions) with intralesional osteophytes among a cohort of 497 ACI patients. Osteophyte regrowth was analyzed on magnetic resonance imaging and categorized as small or large (less or more than 50% of the cartilage thickness). Twenty patients (24 defects) without intralesional osteophytes at the time of ACI acted as control. Results Osteophyte regrowth was observed in 39.5% of lesions (34.4% of small osteophytes and 5.1% of large osteophytes). In subgroup analyses, regrowth was observed in 45.8% of periosteal-covered defects and in 18.9% of collagen membrane–covered defects. Large osteophyte regrowth occurred in less than 5% in either group. Periosteal defects showed a significantly higher incidence for regrowth of small osteophytes. In the control group, intralesional osteophytes developed in 16.7% of the lesions. Conclusions Even though intralesional osteophytes may regrow after removal during ACI, most of them are small. Small osteophyte regrowth occurs almost twice in periosteum-covered ACI. Large osteophytes occur only in 5% of patients. Intralesional osteophyte formation is not significantly different in preexisting intralesional osteophytes and control groups.

scholarly journals 062 BONE-MARROW STIMULATION BY DRILLING VERSUS MICROFRACTURE LEADS TO BETTER CARTILAGE REPAIR IN RABBITS

2009 ◽  
Vol 17 ◽  
pp. S42-S43
Author(s):  
H. Chen ◽  
C.D. Hoemann ◽  
J. Sun ◽  
V. Lascau-Coman ◽  
W. Ouyang ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Cartilage Repair ◽  
Bone Marrow Stimulation ◽  
Marrow Stimulation

scholarly journals Impact of Early Weightbearing After Ankle Arthroscopy and Bone Marrow Stimulation for Osteochondral Lesions of the Talus

2021 ◽  
Vol 9 (9) ◽  
pp. 232596712110298
Author(s):  
Richard M. Danilkowicz ◽  
Nathan L. Grimm ◽  
Gloria X. Zhang ◽  
Thomas A. Lefebvre ◽  
Brian Lau ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Statistical Significance ◽  
Osteochondral Lesion ◽  
Ankle Arthroscopy ◽  
Categorical Variables ◽  
Cartilage Defects ◽  
Osteochondral Lesions ◽  
Bone Marrow Stimulation ◽  
Gold Standard Method ◽  
Marrow Stimulation

Background: Osteochondral lesion of the talus (OLT) may be caused by osteochondritis dissecans, osteochondral fractures, avascular necrosis, or focal arthritic changes. For certain focal cartilage defects, bone marrow stimulation (BMS) has been a widely used technique to restore a fibrocartilage substitute overlying the defect. There are various postoperative weightbearing protocols for this procedure, with no single gold standard method. Purpose: To retrospectively review the outcomes of patients undergoing ankle arthroscopy with concomitant BMS to determine outcomes based on postoperative weightbearing status. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively reviewed the records of patients who underwent ankle arthroscopy with BMS for OLTs between 2015 and 2018. Patients were placed into 2 cohorts based on postoperative immobilization status: the nonweightbearing (NWB) group and the weightbearing-as-tolerated (WBAT) group. Patient characteristics obtained included age, sex, comorbidities, and etiology of talar pathology. Outcomes included the pain visual analog scale (VAS), range of motion (ROM), complications, time to first weightbearing, and the method and length of immobilization. Patients who were lost to follow-up before 30 days were excluded. The chi-square test was used to compare categorical variables between cohorts, and the t test was used for continuous variables. Results: A total of 69 patients met the inclusion criteria for this study, 18 in the WBAT group and 51 in the NWB group. The mean lesion size was 9.48 × 9.21 mm (range, 3-15 mm × 2-20 mm) for the NWB group and 9.36 × 9.72 mm (range, 5-14 mm × 6-20 mm) for the WBAT group ( P > .05). The VAS scores improved from 4.40 to 0.67 for the WBAT group and from 6.33 to 2.55 for the NWB group, with the difference in final values reaching statistical significance ( P = .0002). Postoperative ROM was not significantly different between the groups. There were 4 repeat operations within the NWB cohort. Conclusion: The surgical management of OLTs can be challenging, and the postoperative weightbearing protocol can be an extra obstacle for the patient to navigate. We found no difference in pain, ROM, or complications when allowing immediate, full WBAT.

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