Hyaluronic Scaffold and BMAC in Large Cartilage Lesions: The Biologic Arthroplasty 10-Year Experience

Cartilage injury is a leading cause of functional disability and pain. A number of techniques of cartilage repair are available, with variable outcomes expected, depending on the method used and the characteristic of the cartilage lesion. Cartilage restoration treatments should ideally provide durable repair tissue for a wide range of lesion sizes and types. Advanced cell-based therapies, such as autologous chondrocyte implantation, have been associated with successful long-term results, however, procedures such as this are performed in multiple stages, and can be cost-prohibitive. Increasing attention is being paid to the treatment of early degenerative lesions, with the goal of sparing the patient from total joint arthroplasty, or delaying the need for this type of surgical procedure. Many young and middle-aged patients who present with symptomatic cartilage lesions are not interested in surgical solutions involving joint prostheses, and are actively seeking out new therapeutic alternatives to treat early degenerative cartilage injury. To restore areas of cartilage loss, there is growing interest in the use of mesenchymal stem cells (MSCs), as a one-stage procedure to treat cartilage injury. MSCs have an inherent potential to differentiate into mesenchymal tissues such as cartilage, and these cells are readily obtained from autologous sources, such as bone marrow. In order to perform one-stage cartilage repair using a method that is cost-effective and capable of providing durable clinical outcomes, our center has examined the use of a hyaluronic acid-based scaffold in conjunction with bone marrow aspirate concentrate (HA-BMAC), and medium-term results have demonstrated encouraging treatment success, comparable to other methods of cell-based therapy.