Table 3.
Main biomaterials used with PRP and/or BMAC to treat cartilage and bone injuries.
| Tissue | Study | Biomaterial | Formulation | Preparation (PRP/BMAC) |
Follow-up | Findings |
|---|---|---|---|---|---|---|
| Bone | Dallari et al., 2007 [103] | Bone Chip | Scaffold | PRP/BMAC | 1 year | (=) No significant difference between PRP/BMAC groups and empty lyophilized bone controls as all patients reported relieved knee pain and full range of motion. |
| Sauerbier et al., 2010 [106] | Bovine Bone Mineral | Particles | BMAC | 4 months | (=) New bone formation was 19.9% but not significantly different from the synthetic polysaccharide isolation method control. | |
| Jager et al., 2011 [104] | Collagen | Sponge | BMAC | 1 year | (+) Radiography showed significant bone remodeling in all groups, but healing was longer when compared to BMAC/hydroxyapatite controls. | |
| Yassibag-Berkman et al., 2007 [107] | β-TCP | Slurry | PRP | 1 year | (=) No significant difference between clinical parameters in PRP and control groups | |
| Attia et al., 2010 [108] | β-TCP | Slurry | PRP | 1 year | (+) Significant reduction of probing depth and increase in clinical attachment gain (p < 0.01) | |
| Saini et al., 2011 [109] | β-TCP | Slurry | PRP | 9 months | (+) Significant decrease in pocket depth and increase in clinical attachment (p < 0.05) in β TCP/PRP compared to β TCP alone | |
| Özdemir et al., 2012 [110] | β-TCP | Slurry | PRP | 6 months | (=) All 6 parameters evaluating clinical outcome were not significant between PRP and control groups (p < 0.05) | |
| Okuda et al., 2005 [111] | HAp | Scaffold | PRP | 1 year | (+/−) There were significant differences in gingival index, bleeding on probing, probing depth and clinical attachment level, in PRP groups compared baseline (p < 0.001), and significant differences in PRP versus control groups in probing depth, clinical attachment gain, and vertical attachment (p < 0.05) No significant difference in defect change between PRP scaffolds versus saline scaffolds, however, positive significant gain was seen compared to baseline measurements (p < 0.01) |
|
| Vaishnavi et al., 2011 [112] | HAp | Scaffold | PRP | 1 year | (=) Radiographic evaluation showed bone regeneration in all groups (scaffold, PRP, scaffold with PRP) except the negative control | |
| Menezes et al., 2012 [113] | HAp | Scaffold | PRP | 4 years | (+) Significant differences in defect fill were seen in PRP/hydroxyapatite treated group compared to hydroxyapatite/saline control (p < 0.001) | |
| Kutkut et al., 2012 [114] | MGCSH | Scaffold | PRP | 3 months | (+) Radiographic evaluation confirmed more dense bone in MGCSH and PRP groups compared to empty MGCSH, and histomorphic analysis showed a statistically significant difference between these groups (p < 0.05) | |
| Cartilage | Siclari et al., 2012, 2014 [81,115,116] | PLGA-HA | Matrix | PRP | 1–5 years | (+) Histology showed homogenous repair tissues and good integration of repair tissues to the subchondral bone and adjacent cartilage and immunohistochemistry showed signs of hyaline like cartilage formation. At 2 years, hyaline-to hyaline cartilage repair tissue that was rich with a chondrocyte morphology, proteoglycans, and type-II collagen. At 4 years, MRI confirmed good defect and volume filling in 20 of 21 patients and received high MOCART scores. |
| Siclari et al., 2018 [117] | PLGA-HA | Matrix | PRP | 2 years | (+) AOFAS rating increased significantly (p < 0.01). ROM increased significantly (p < 0.01). | |
| Enea et al., 2013 [118] | PLGA-HA | Matrix | BMAC | 2 years | (+) MRIs showed all patients had complete defect and volume filling and resurfacing of articular cartilage to previous cartilage level. Some bone marrow edema and subchondral irregularities were observed—as well subchondral irregularities. | |
| Giannini et al., 2009 [119] | HA | Membrane | BMAC | 2 years | (+) MRI done 12 months postoperatively showed tissue regeneration in all 48 patients. Integration with the healthy cartilage was complete, and transition zones were smooth in all patients. Immunohistologic results confirmed new cartilaginous tissues with varied hyaline cartilage tissue remodeling. | |
| Buda et al., 2010 [120] | HA | Scaffold | BMAC | 2 years | (+) Post-treatment IKDC and KOOS scores were significantly higher than pre-treatment (p < 0.0005). MRIs taken at 1 and 2 years after treatment shown subchondral bone and cartilage regeneration. Histological analysis showed a proteoglycan rich matrix and collagen II throughout the regenerated tissue. | |
| Gobbi et al., 2016 [121] | HA | Scaffold | BMAC | 5 years | (+) All HA-BMAC scaffold treated patients maintained classification as normal or nearly normal by IKDC, KOOS, Tegner, and Lysholm. No quality of repair studies were done in this study. | |
| Gobbi et al., 2017 [122] | HA | Scaffold | BMAC | 4 years | (+) KOOS, IDKC, Tegner, and VAS scores were significantly improved in both the over and under 45 year-old groups. MRI determined 80% defect filling in the over 45 group and 71% defect filling in the under 45 group, and histology on 3 and 2 patients from these groups, respectively, showed good tissue repair with varying amounts of hyaline-like tissue. | |
| Dhollander et al., 2011 [123] | Collagen | Scaffold | PRP | 2 years | (+) VAS, Tegner, Kujala patellofemoral, and KOOS scores showed improvement. MRI data showed incomplete filling in 3/5 patients, hypertrophy in 2/5 patients. Complete integration with adjacent was observed in all patients, but the surface of the repair tissue was irregular in all patients during 1 year and 2 year post-operative scans. MOCART scores remained stable during the 2 year period. | |
| Enea et al., 2015 [124] | Collagen | Membrane | BMAC | 2 years | (+/−) Significant (p < 0.05) IKDC subjective score improvement, Lysholm score, VAS, and activity level pre vs. post-operative, but no change in Tegner score. MRI scans taken between 6–9mo after surgery showed reconstitution of original cartilage levels, bone marrow edema and/or subchondral; irregularities for all cases. Histologically, only 1/5 had hyaline-like matrix, and that matrix did not exhibit cell arrangements of normal articular cartilage. | |
| Gigante et al., 2012 [82] | Collagen | Membrane | BMAC | 2 year | (+) Full weight bearing in 6 weeks, jogging at 6 months, continuously asymptomatic at 24 months. MRI scan at 12 months showed good defect filling with tissue signal signals similar to that or surrounding tissue without signs of bone marrow edema. | |
| Gigante et al., 2011 [125] | Collagen | Scaffold | BMAC | 1 year | (+/−) All 5 patients self-reported themselves as asymptomatic. Mean histological scores of 59.8(SD 14.5). 1 had hyaline-like cartilage,3 had hyaline/fibrocartilage, and 1 had fibrocartilage formation. Columnar structures of normal articular cartilage were not observed in any case. | |
| Giannini et al., 2013 [126] | Collagen | Scaffold | BMAC | 4 years | (+/−) AOFAS score improved significantly (p < 0.0005) at 24mo, but decreased significantly between 24mo and 36mo (p < 0.001), and 24mo to 48mo (p < 0.005). MRI T2 mapping analysis showed that regenerated tissue has similar values to that of hyaline cartilage −9/20 had complete defect filling and 13/20 had tissue integration at the border zone. However, a majority of patients also had damaged subchondral lamina, disrupted subchondral bone, and subchondral edema. | |
| Gobbi et al., 2011 [127] | Collagen | Matrix | BMAC | 2 years | (+) Visual analog scale (VAS), IKDC, KOOS, Lysholm, Marx, SF-36, and Tegner scores all showed significant improvement after the final follow-up of 15 patients (p < 0.005). MRI T2 and histology showed hyaline like cartilage formation and complete defect filling of 12 of 15 patients with no signs of hypertrophy. Integration with adjacent cartilage was complete in 14 of those same patients. | |
| Krych et al., 2016 [105] | PLGA | Scaffold | PRP/BMAC | 1 year | (+) No subjective clinical outcome measures were included in 11 control patients, 23 PRP treated patients, and 12 BMAC treated patients. PRP and BMAC patients both had significantly (p < 0.002, p < 0.03) better fill than the control and was more hyaline like as determined my MRI T2 mapping. | |
| Skowronski et al. 2013 [128] | Collagen | Membrane | BMAC | 5 years | (+) An improvement was observed in 52 out of 54 patients in all scales (KOOS, Lysholm, VAS, KOOs pain) after comparison between Preoperative and 12 months post-operatively. No differences were observed between 12 months and 5 years after surgery. |
(+) superior results, (−) inferior results, (=) similar results, AOFAS = American Orthopaedic Foot and Ankle Society, HA = hyaluronic acid, Hap = hydroxyapatite, IKDC = International Knee Documentation Committee, MGCSH = medical-grade calcium sulfate hemihydrate, MOCART = Magnetic Resonance Observation of Cartilage Tissue, MRI = magnetic resonance imaging, PLGA-HA = poly(glycolic acid)-hyaluronic acid, VAS = visual analog scale, KOOS = Knee injury Osteoarthritis Outcome Score, β-TCP = β-tricalcium phosphate.