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One-step Bone Marrow-derived Cell Transplantation in Talar Osteochondral Lesions

  • Original Article
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Clinical Orthopaedics and Related Research®

Abstract

The ideal treatment of osteochondral lesions is debatable. Although autologous chondrocyte implantation provides pain relief, the need for two operations and high costs has prompted a search for alternatives. Bone marrow-derived cells may represent the future in osteochondral repair. Using a device to concentrate bone marrow-derived cells and collagen powder or hyaluronic acid membrane as scaffolds for cell support and platelet gel, a one-step arthroscopic technique was developed for cartilage repair. We performed an in vitro preclinical study to verify the capability of bone marrow-derived cells to differentiate into chondrogenic and osteogenic lineages and to be supported onto scaffolds. In a prospective clinical study, we investigated the ability of this technique to repair talar osteochondral lesions in 48 patients. Minimum followup was 24 months (mean, 29 months; range, 24–35 months). Clinical results were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) score and the influence of scaffold type, lesion area, previous surgeries, and lesion depth was considered. MRI and histologic evaluation were performed. The AOFAS score improved from 64.4 ± 14.5 to 91.4 ± 7.7. Histologic evaluation showed regenerated tissue in various degrees of remodeling although none showed entirely hyaline cartilage. These data suggest the one-step technique is an alternative for cartilage repair, permitting improved functional scores and overcoming the drawbacks of previous techniques.

Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Carola Cavallo, PhD, for bioptic evaluation and preclinical analysis; Annarita Cenacchi, MD, and Annalisa Gabriele, MD, Immunohematology and Transfusional Service, Istituto Ortopedico Rizzoli, for bone marrow harvesting and concentration procedures; and Keith Smith for English revision.

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Authors and Affiliations

  1. VI Department of Orthopaedic and Traumatology, Istituto Ortopedico Rizzoli, University of Bologna, Via GC Pupilli 1, 40136, Bologna, Italy

    Sandro Giannini MD, Roberto Buda MD, Francesca Vannini MD, PhD & Marco Cavallo MD

  2. Laboratory of Immunology and Genetics, Istituto Ortopedico Rizzoli, Bologna University, Bologna, Italy

    Brunella Grigolo PhD

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  1. Sandro Giannini MD
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  2. Roberto Buda MD
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  3. Francesca Vannini MD, PhD
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  4. Marco Cavallo MD
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  5. Brunella Grigolo PhD
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Correspondence to Marco Cavallo MD.

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One or more of the authors (SG, BG) received funding from the Fondazione Monte dei Paschi di Siena.

Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Giannini, S., Buda, R., Vannini, F. et al. One-step Bone Marrow-derived Cell Transplantation in Talar Osteochondral Lesions. Clin Orthop Relat Res 467, 3307–3320 (2009). https://doi.org/10.1007/s11999-009-0885-8

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  • DOI: https://doi.org/10.1007/s11999-009-0885-8

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