Alberto Gobbi, MD, and Graeme P. Whyte, MD, MSc, FRCSC
Investigation performed at OASI Bioresearch Foundation, Milan, Italy
Am J Sports Med published online July 29, 2016
This is a groundbreaking European study, with five-year results, demonstrating the superiority & durability of stem cell surgery (not just injection) to microfracture. This study will now be carried out in the US. -Kelly Cunningham MD
Background: Articular cartilage injury is frequently encountered, yet treatment options capable of providing durable cartilage repair are limited.
Purpose: To investigate the medium-term clinical outcomes of cartilage repair using a 1-stage technique of a hyaluronic acid–based scaffold with activated bone marrow aspirate concentrate (HA-BMAC) and compare results with those of microfracture. A secondary aim of this study was to identify specific patient demographic factors and cartilage lesion characteristics that are
associated with superior outcomes.
Study Design: Cohort study; Level of evidence, 2.
Methods: Fifty physically active patients (mean age, 45 years) with grade IV cartilage injury of the knee (lesion size, 1.5-24 cm2) were treated with HA-BMAC or microfracture and were observed prospectively for 5 years. Patients were placed into the HABMAC group if the health insurance policy of the treating institution supported this option; otherwise, they were placed into
the microfracture group. Objective and subjective clinical assessment tools were used preoperatively and at 2 and 5 years postoperatively to compare treatment outcomes.
Results: Significant improvements in outcome scores were achieved in both treatment groups at 2 years (P\.001). In the microfracture group, 64% were classified as normal or nearly normal according to the International Knee Documentation Committee (IKDC) objective score at 2 years, compared with 100% of those treated with HA-BMAC (P \ .001). Normal or nearly normal
objective assessments in the microfracture group declined significantly after 5 years to 28% of patients (P = .004). All patients treated with HA-BMAC maintained improvement at 5 years according to Lysholm, Tegner, IKDC objective, and IKDC subjective scores. Tegner, IKDC objective, and Knee injury and Osteoarthritis Outcome Score (KOOS) assessments demonstrated higher
scores in the HA-BMAC treatment group compared with microfracture at 5 years. Lysholm and IKDC subjective scores were similar between treatment groups at 5 years. Poorer outcomes in the microfracture group were demonstrated in cases of lesions larger than 4 cm2 and nonsolitary lesions. Age greater than 45 years, large size of lesion, and treatment of multiple lesions
were not associated with poorer outcome in patients treated with HA-BMAC.
Conclusion: Repair of chondral injury using a hyaluronic acid–based scaffold with activated bone marrow aspirate concentrate provides better clinical outcomes and more durable cartilage repair at medium-term follow-up compared with microfracture. Positive short-term clinical outcomes can be achieved with either microfracture or HA-BMAC. Cartilage repair using HA-BMAC leads to successful medium-term outcomes independent of age or lesion size.
Disclaimer: Austin Ortho+Biologics is not affiliated with the data, content, or conclusions of this article.
