Original Article
Articular Cartilage Regeneration With Autologous Peripheral Blood Progenitor Cells and Hyaluronic Acid After Arthroscopic Subchondral Drilling: A Report of 5 Cases With Histology

https://doi.org/10.1016/j.arthro.2010.11.054Get rights and content

Purpose

The purpose of this study was to evaluate the quality of articular cartilage regeneration after arthroscopic subchondral drilling followed by postoperative intraarticular injections of autologous peripheral blood progenitor cells (PBPCs) in combination with hyaluronic acid (HA).

Methods

Five patients underwent second-look arthroscopy with chondral core biopsy. These 5 patients are part of a larger pilot study in which 180 patients with International Cartilage Repair Society grade III and IV lesions of the knee joint underwent arthroscopic subchondral drilling followed by postoperative intra-articular injections. Continuous passive motion was used on the operated knee 2 hours per day for 4 weeks. Partial weight bearing was observed for the first 6 to 8 weeks. Autologous PBPCs were harvested 1 week after surgery. One week after surgery, 8 mL of the harvested PBPCs in combination with 2 mL of HA was injected intra-articularly into the operated knee. The remaining PBPCs were divided into vials and cryopreserved. A total of 5 weekly intra-articular injections were given.

Results

Second-look arthroscopy confirmed articular cartilage regeneration, and histologic sections showed features of hyaline cartilage. Apart from the minimal discomfort of PBPC harvesting and localized pain associated with the intra-articular injections, there were no other notable adverse reactions.

Conclusions

Articular hyaline cartilage regeneration is possible with arthroscopic subchondral drilling followed by postoperative intraarticular injections of autologous PBPCs in combination with HA.

Level of Evidence

Level IV, therapeutic case series.

Section snippets

Patient Selection

Five patients underwent second-look arthroscopy with chondral core biopsy. These 5 patients are part of a larger pilot study in which 180 patients who presented with chondral defects of the knee joint were recruited. Postoperatively, the clinical course of these 5 patients presented an opportunity for a second-look arthroscopy. Two patients underwent contralateral knee surgery, and one patient had removal of a Tomofix plate and screw construct (Synthes, West Chester, PA), providing an opportune

Second-Look Arthroscopy With Chondral Core Biopsy

Five patients underwent second-look arthroscopy, and a 2-mm chondral core biopsy specimen was procured and examined. Arthroscopically, the regenerated articular cartilage appeared smooth and had excellent integration to the surrounding native cartilage without any delamination or hypertrophy. The exception was case 2, in which the drill holes over the lateral patellofemoral joint were too far apart with resultant tufts of cartilage seen between areas devoid of regenerated cartilage (Fig 3).

Histology

Discussion

It was possible to replicate our preclinical animal model8 in the human knee joint using postoperative intra-articular injections of autologous PBPCs in combination with HA after arthroscopic subchondral drilling. This method uses marrow stimulation to create an autologous scaffold that is subsequently seeded with postoperative intra-articular injections of autologous PBPCs and in situ progenitor cells from the marrow (Fig 10).

Histologic results after microfracture and autologous chondrocyte

Conclusions

Articular hyaline cartilage regeneration is possible with arthroscopic subchondral drilling followed by postoperative intraarticular injections of autologous PBPCs in combination with HA.

References (21)

There are more references available in the full text version of this article.

Cited by (141)

  • New frontiers for cartilage repair, joint preservation and prevention

    2022, Journal of Cartilage and Joint Preservation
  • Mobilized Peripheral Blood Stem Cells are Pluripotent and Can Be Safely Harvested and Stored for Cartilage Repair

    2021, Arthroscopy - Journal of Arthroscopic and Related Surgery
    Citation Excerpt :

    A significant decrease in CD34+ was also observed 24 hours after processing with DMSO (Mdiff = 0.20 × 106/4 mL vial; P = .017; 95%CI: 0.05, 0.35). Similar results and trend of CD34+ has been observed and reported.22 The data from samples shipped to and from the United States test site are presented in Tables 2 and 3.

View all citing articles on Scopus

The authors report no conflict of interest.

View full text