Osteochondral Lesions of the Knee: A New One-Step Repair Technique with Bone-Marrow-Derived Cells

Abstract

Osteochondral lesions of the knee are defects of the cartilaginous surface and underlying subchondral bone, most frequently traumatic in origin1. These lesions are predominantly located on the medial femoral condyle, and associated ligamentous or meniscal pathology is reported in 40% of cases2,3 (Fig. 1). Biomechanical studies have demonstrated increased stress concentration on the rim of the osteochondral defect, which may have important implications for cartilage longevity4. Due to poor hyaline cartilage repair capability, larger osteochondral lesions of the knee are associated both with immediate significant clinical impairment and with symptoms appearing approximately one decade earlier than the degenerative cartilage changes that are associated with idiopathic osteoarthritis5. Fig. 1 Fig. 2 Fig. 1 Osteochondral lesions can affect all areas of articular cartilage, but the femoral condyle is most often involved. Fig. 2 Bone marrow is aspirated from the posterior iliac crest. Surgery is frequently needed to treat knee symptoms in patients with osteochondral lesions of the knee and to restore the cartilage on the articular surface, which lessens the risk of the development of osteoarthritis6-8. Various surgical options have been proposed for osteochondral repair6-9 but only a few have shown the ability to provide repair of the lesion site with hyaline cartilage5,10-12. Traditionally, hyaline cartilage repair has been achieved through cartilage replacement (osteoarticular transfer system [OATS; Arthrex, Naples, Florida], which is a type of mosaicplasty)13 or cartilage regeneration through autologous chondrocyte implantation6,14. Cartilage replacement procedures have the advantage of repairing cartilage defects with use of already mature autologous cartilage cells; however, donor-site pathology, discontinuity in the orientation of the cartilage plugs, and fibrocartilage in the gaps are disadvantages of these techniques13. Cartilage regeneration by autologous chondrocyte …