A hyaluronic acid-based scaffold with bone marrow aspirate concentrate used in patients with a chondral injury achieved better outcomes and more durable cartilage repair at medium-term follow-up than microfracture.
“Repair of cartilage lesions in the knee using a hyaluronic acid (HA)-based scaffold in combination with bone marrow aspirate concentrate demonstrates superior clinical outcomes after 5 years than the more commonly used technique of microfracture,” Alberto Gobbi, MD, of the OASI Bioresearch Foundation in Milan, told Orthopedics Today. “Furthermore, good to excellent clinical outcomes using [a HA]-based scaffold in combination with bone marrow aspirate concentrate were achieved in a wide variety of cartilage lesion sizes and across a wide range of patient ages.”
HA-BMAC vs microfracture
Gobbi and Graeme P. Whyte, MD, MSc, FRCSC, compared outcomes at 2 years and 5 years in 50 patients with grade IV cartilage injuries of the knee who underwent treatment with either a HA-based scaffold (Hyalofast, Anika Therapeutics) combined with bone marrow aspirate concentrate (HA-BMAC) or microfracture alone.
At 2-year follow-up, results showed both groups had significant improvements in outcome scores, with 64% of patients in the microfracture group and 100% of patients in the HA-BMAC group classified as normal or nearly normal based on IKDC objective scores. Researchers noted a significant decline in normal or nearly normal objective assessments for 28% of patients in the microfracture group after 5 years. Lysholm, Tegner, IKDC objective and IKDC subjective scores showed all patients treated with HA-BMAC maintained improvement at 5 years. Researchers found the HA-BMAC treatment group demonstrated higher scores in the Tegner, IKDC objective and KOOS assessments compared with the microfracture group, but both patient groups had similar Lysholm and IKDC subjective scores at 5 years.
Although patients in the microfracture group with lesions larger than 4 cm2 and non-solitary lesions had poorer outcomes, HA-BMAC used in patients older than 45 years with a large size lesion and who underwent treatment of multiple lesions was not associated with poorer outcomes.
New techniques explored
“This one-step surgery to treat cartilage injury has potential for widespread use given the encouraging clinical results and attractive cost profile of the procedure,” Gobbi said. “If compared with traditional [autologous chondrocyte implantation] ACI procedures used in the United States, the cost is 10-times less. Many active patients present with cartilage injury to the knee, and this type of joint preserving procedure will hopefully provide a treatment option [to] maintain function over the medium to long term.”
Using newly designed instruments called the Chondrectomes Set (ATMED-Z), Gobbi and Whyte are working on minimally invasive methods of performing HA-BMAC. Work is being done on osteochondral lesion repair using the Hyalofast scaffold with BMAC, as well as morselized bone graft using biologic inlay osteochondral reconstruction. – by Casey Tingle
- Gobbi A, et al. Am J Sports Med. 2016;doi:10.1177/0363546516656179.
- For more information:
- Alberto Gobbi, MD, can be reached at Via G.A. Amadeo, 24, 20133 Milan, Italy; email: firstname.lastname@example.org.
Disclosure: Gobbi reports he is a scientific consultant for Anika.