TABLE 1.
Focal Cartilage Defect Studiesa
| Study | Study Type (N) | Age, y, Mean (Range) | Follow-up, mo (Range) | Size and Location | Treatment | Additional Factors | Results | Radiologic Findings | Second-Look Arthroscopy | Conclusion | Complications |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Gobbi et al10 | P (15) | 48 (32-58) | 24 (24-38) | Mean size: 9.2 cm2; 7 patella, 6 trochlea, 4 MTP, 6 MFC, 1 LFC | BMAC covered with collagen I/III matrix | — | Significant improvement in Tegner, Lysholm, KOOS, Marx, IKDC, SF-36 scores | MRI showed complete coverage of lesions with hyaline-like cartilage in 80% | Normal to nearly normal tissue | 1-step technique with BMAC and collagen I/III matrix is a viable treatment for grade 4 knee chondral lesions | None reported |
| Gobbi et al9 | P (25) | 46.5 (32-58) | Min: 36 Mean: 41.3 | Mean size: 8.3 cm2; MFC 40.5%, patella 24.5%, trochlea 21.5% | BMAC covered with collagen I/III matrix | Ligament injuries, tibiofemoral malalignment, patellofemoral malalignment | Significant improvement in all scores: VAS, from 5.4 to 0.48; IKDC, from 37.9 to 81.7; Lysholm, from 46.4 to 86.5; Tegner, from 2.1 to 5.6 | Good stability of the implant and complete coverage of lesion in 80% of patients | Smooth newly formed tissues continuous with healthy cartilage | Treatment of large chondral defects with MSC is an effective procedure and can be performed routinely in clinical practice | None reported |
| Gobbi et al8 | P (MACI: 19, BMAC: 18) | MACI: 43 BMAC: 44.5 | Min: 36 MACI: 60 BMAC: 54 | Mean size: 5.5 cm2 (BMAC), 5.5 cm2 (MACI); PF | Comparative study: MACI vs BMAC | Patellofemoral realignment: 8 MACI, 5 BMAC HTO: 3 MACI, 5 BMAC ACLR: 1 MACI, 2 BMAC | Significant improvement in all scores; no significant difference between groups except IKDC (higher in BMAC group) | Complete filling of defects in 76% of MACI patients and 81% of the BMAC group | Hyaline-like features | Both treatments are viable and effective for large patellofemoral chondral lesions at 3-y follow-up | BMAC group: 1 MACI group: 1 Both required debridement and mobilization for intra-articular adhesions |
| Gigante et al7 | CR (1) | 37 | 24 | Size: 3 cm2; MFC | Microfracture covered with BMAC and scaffold | Microfracture | Patient asymptomatic at 24 mo | MRI at 12 months showed good defect filling with tissue signal similar to surrounding tissue. No signs of bone marrow edema | — | Covered microfracture and bone marrow concentrate is a safe and effective technique and can be adopted with an all-arthroscopic technique to treat lesions >2 cm2 | None reported |
| Enea et al4 | CS (9) | 48 | 22 | Size: 1.9-9 cm2; 7 MFC, 2 LFC | Single-stage microfracture covered with polymer-based matrix and BMAC | 1 ACL calcification removal, 1 osteochondral fixation, 1 meniscectomy, 1 trochlea resurfacing | Significant improvement in VAS pain, Lysholm, IKDC scores. Tegner score: no significant difference between pre- and postoperative but significantly better between postinjury and postoperative | Complete defect and volume filling in all patients. | 1/5 normal, 3/5 nearly normal, 1/5 abnormal. Histology showed hyaline-like repair tissue | Single-stage treatment of focal cartilage defects with microfracture and PGA-HA matrix augmented with autologous BMC is safe, improves knee function, and has potential to regenerate hyaline-like cartilage | None reported |
| Enea et al3 | CS (9) | — | 29 | Mean size: 2.6 cm2; 6 MFC, 1 LFC, 1 LFC and trochlea | Single-stage microfracture covered with collagen and BMAC | Microfracture in all patients, 1 partial meniscectomy, 1 synovectomy | Significant improvement in VAS pain, Lysholm, IKDC scores. Tegner score: no significant difference between pre- and postoperative, but significantly improved between postinjury and postoperative | Reconstitution of the original cartilage level. Bone marrow edema and/or subchondral irregularities observed in all patients | 4 patients evaluated: nearly normal, ICRS CRA grade 2. Histology: hyaline-like cartilage in 1 patient, fibrocartilage in 2, and mixed hyaline and fibrocartilage in 1 | Treatment with collagen-covered microfracture and bone marrow concentrate for focal cartilage defects in the knee is safe, improves knee function, and has potential to regenerate hyaline-like cartilage | None reported |
| Skowroński et al32 | P (54) | 18-55 | 60 | Mean size: 26.2 cm2; 59% MFC, 19% patella, 7% LFC | BMAC with collagen membrane | 7 patients had ACLR, 3 varus osteotomies, 6 patients had correction patella path | Significant improvements in Lysholm and KOOS scores in 96% of patients | — | — | 1-stage repair of large chondral lesions with BMAC is an effective treatment modality | Not reported |
| Skowroński and Rutka31 | P (46) | 26 (17-52) | 60 | >4 cm2 wide, >6 mm deep; MFC | MSC from peripheral blood vs BMC; 21 patients BMC, 25 patients MSC from peripheral blood | — | Significant improvements in all scores in both groups; VAS, Lysholm, KOOS in 86% of the patients. Treatment with MSC from peripheral blood had superior results. | Satisfactory reconstruction of the cartilaginous surface and good regenerate integration | — | Modified sandwich reconstruction is an effective treatment modality for severe osteochondral lesions. Slightly poorer results in the group treated with BMC compared with MSC from peripheral blood. | Not reported |
aACLR, anterior cruciate ligament reconstruction; BMAC, bone marrow aspirate concentrate; BMC, bone marrow concentrate; CR, case report; CS, case series; HTO, high tibial osteotomy; ICRS CRA, International Cartilage Repair Society cartilage repair assessment; IKDC, International Knee Documentation Committee; KOOS, Knee injury and Osteoarthritis Outcome Score; LFC, lateral femoral condyle; MACI, matrix-induced autologous chondrocyte implantation; MFC, medial femoral condyle; MSC, mesenchymal stem cell; MRI, magnetic resonance imaging; MTP, medial tibial plateau; P, prospective; PF, patellofemoral chondral lesions; PGA-HA, polyglycolic acid–hydroxyapatite; VAS, visual analog scale.