Bone marrow aspirate concentrate, hyaluronan-based scaffold effective for cartilage lesions in older patients

Results from this study demonstrated bone marrow aspirate concentrate and a hyaluronan-based scaffold is viable and effective for the treatment of cartilage lesions, and its efficacy is not impacted by patient age.

Perspective from Bryan M. Saltzman, MD

Researchers compared 20 patients older than 45 years (study group) with 20 patients who were younger than 25 years (control group). All patients had full-thickness cartilage lesions of the knee joint and underwent cartilage implantation with bone marrow aspirate concentrate that was harvested from autologous, adult mesenchymal stem cells and placed on a hyaluronan-based scaffold. Investigators prospectively evaluated patients for 4 years. With MRI, KOOS, IDKC, VAS and Tegner scores, patients were assessed preoperatively and at the final follow-up.

Results at the final follow-up showed KOOS, Tegner and IKDC scores improved significantly for both groups. Investigators noted the lesion size and number of lesions impacted the results; however, concomitant surgical procedures did not alter outcomes. Findings from the MRI demonstrated 80% of study patients and 71% of control patients had complete filling. Good tissue repair with a changeable amount of hyaline-like tissue was seen in three patients from the study group and in two patients from the control group– by Monica Jaramillo

Disclosure : Gobbi reports he is a scientific consultant for Anika Therapeutics Inc.

Perspective

Bryan M. Saltzman, MD

In their study entitled, “One-step surgery with multipotent stem cells and hyaluronan-based scaffold for the treatment of full-thickness chondral defects of the knee in patients older than 45 years,” Gobbi and colleagues prospectively evaluated the medium-term efficacy of autologous bone marrow aspirate concentrate (BMAC) with a hyaluronan-based scaffold (Hyalofast) in the treatment of ICRS grade 4 lesions of the knee. The cohort included only 20 patients, with a mean age of 50 years, compared with a control cohort of 20 patients, younger than 45 years of age (mean 36.6 years), at 4-years follow-up. The authors demonstrated significant improvements in several patient-reported outcome measures (KOOS and subcategories, Tegner, IKDC subjective), MRI findings with complete filling in 80% of study patients (vs. 71% of control group patients) and superior outcomes for patients with single, smaller lesions, regardless of concomitant procedures.

Despite being limited by a high number of potentially confounding concomitant surgeries in the study cohort and a small cohort size limiting subgroup analysis, BMAC and Hyalofast appeared to be a safe, viable and effective option for the treatment of patients older than 45 years of age with full-thickness chondral defects of the knee that can provide comparable functional outcomes to their younger counterparts.

Bryan M. Saltzman, MD

Department of orthopedic surgery

Rush University Medical Center

Chicago

Disclosures: Saltzman reports no relevant financial disclosures.

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Source:

Gobbi A, et al. Knee Surg Sports Traumatol Arthrosc. 2017;doi:10.1007/s00167-016-3984-6.