Autologous bone marrow and
collagen matrix, when used as one-step procedure for patients
full-thickness knee cartilage lesions, demonstrated
significant improvements on many outcome measures, according to an Italian
Alberto W. Gobbi, MD, of Milan, presented his
teams findings at the
2011 Annual Meeting of the Arthroscopy Association of North
This is a one-step procedure for cartilage
transplantation, Gobbi said. It is a user-friendly technique. It
has a low cost, if you compare it with standard [autologous chondrocyte
implantation] procedures. Of course, we need more prospective randomized
The purpose of his presented study was to determine how
effective the treatment would be when assessed with a variety of scoring
Gobbi and his group prospectively studied 25 patient s
who underwent treatment for grade IV cartilage lesions of the knee. Each
patient underwent mini arthrotomy and concomitant transplantation of bone
marrow aspirate concentrate covered with a collagen matrix.
Gobbi noted that co-existing pathologies received
treatment either before or during the surgery, and each patient followed a
specific rehabilitation program for at least 6 months. Ten patients displayed
multiple chondral lesions.
These patients had big defects, Gobbi said.
[The] average size was 8.3 cm².
marrow aspirate concentrate clot after activation is shown.
Image: Gobbi AW
The team collected X-rays and MRIs preoperatively, at 1
year and at final follow-up. In addition, the investigators assessed patients
using the Knee injury and Osteoarthritis Outcome Score (KOOS), visual analogue
scale (VAS), International Knee Documentation Committee (IKDC), Lysholm, Marx,
SF-36 and Tegner scores. The patients had an average follow-up of 2 years.
The Wilcoxon rank test was used to compare the scores,
and Gobbi added that six patients consented to a second-look arthroscopy. Five
patients consented to a concomitant biopsy.
Gobbi reported his team found significant improvement in
all measured parameters at the final follow-up. Preoperative to final follow-up
improvements included 5.2 to 0.7 on the VAS, 43.6 to 80.7 on the IKDC
subjective scale, 60.4 to 92.9 on the Lysholm, 4.2 to 10.3 on the Marx and 2.0
to 4.9 on the Tegner.
MRI results, Gobbi added, displayed strong coverage of
the lesions as well as satisfactory tissue quality. There were no adverse
reactions or postoperative complications.
Finally, we wanted to compare single vs. multiple
lesions, and we found that patients with a single lesion showed a better
improvement than patients with multiple lesions, Gobbi said. We
also compared smaller vs. larger lesions, and patients with a smaller lesion
size showed better improvement than patients with a larger lesion
size. by Robert Press
- Gobbi AW, Karnatzikos G, Mahajan V. The use of bone marrow aspirate
concentrated for full-thickness knee cartilage lesions in a one-step procedure:
A prospective study. Paper #SS-25. Presented at the 2011 Annual Meeting of the
Arthroscopy Association of North America. April 14-16. San Diego.
- Alberto W. Gobbi, MD, can be reached at Orthopaedic Arthroscopic
Surgery International (OASI) Bioresearch Foundation, 24 Via Amadeo GA, Milan
20133, Italy; email: firstname.lastname@example.org.
- Disclosure: Gobbi and co-authors have no relevent financial
Gobbis paper on bone marrow aspiration certainly
is a very attractive procedure one step, using the patients own
bone marrow aspirate. One thing I would caution the readers with is that it is
not yet clear to me whether or not this is FDA-approved. Before you go out and
do that, I would make sure you look into it.
Peter R. Kurzweil, MD
Disclosure: He is a member of the speakers bureau for Covidien, an
unpaid consultant for Pierce Surgical Corporation, a stockholder in Orteg, a
member of the editorial or governing board for Sport Medicine and
Arthroscopy Review and Orthopedics Today, and a board member
of the Arthroscopy Association of North America.