Osteochondral Patello-Femoral Lesions Treated With One Step Surgery Using Bone Marrow Derived Mesenchymal Stem Cells: Results at Three Years (SS-26)

Abstract

The purpose of our study was to determine the effectiveness of cartilage repair in patello- femoral lesions utilizing a one step surgery with Bone Marrow Aspirate Concentrated (B.M.A.C.) and collagen I/III matrix. Good results have been published with the two-step Autologous Chondrocyte Implantation but very few studies have analyzed single step procedure with bone marrow derived mesenchymal cells. We prospectively followed up for 3yrs, 15 patients (mean age 48 years) operated at our Institution from April 2007 for grade IV patello femoral osteochondral lesions of the knee. The average size of the lesions was 7.3 cm2. All patients were transplanted with Bone Marrow Aspirate Concentrated (B.M.A.C.) covered with collagen matrix (ChondroGide-Geistlich Wolhusen, CH). Bone marrow was harvested from ipsilateral iliac crest and subjected to concentration and activation with Batroxobin solution (Plateltexact-Plateltex S.R.O. Bratislava, SK). All patients followed the same specific rehabilitation program for a minimum of 6 months. X-rays and MRI were collected preoperative and at final follow up. VAS, IKDC, KOOS, Lysholm, Marx, and Tegner scores were collected at pre-op, 6, 12,18 months and at final follow up. Four patients gave their consent for second-look arthroscopy and two of them for a concomitant biopsy Patients showed significant improvement in all scores at 6, 12, 24 and 36 months follow up (p < 05). Patients presenting with small lesions (1-5cm2) showed higher improvement. No adverse reactions or post–op complication were noted. MRI showed good coverage of the lesions. Hyaline-like histological findings were reported for the specimens analysed. This study shows that one-step surgery with B.M.A.C. and collagen scaffold can be a viable technique in the treatment of grade IV patello-femoral osteochondral lesions.