Bone Marrow Aspirate Concentrate for Cartilage Defects of the Knee: From Bench to Bedside Evidence

被引:78
作者
Cotter, Eric J. [1 ]
Wang, Kevin C. [2 ]
Yanke, Adam B. [2 ]
Chubinskaya, Susan [3 ]
机构
[1] Georgetown Univ, Sch Med, Washington, DC USA
[2] Rush Univ, Med Ctr, Dept Orthopaed Surg, Chicago, IL 60612 USA
[3] Rush Univ, Dept Pediat, Med Ctr, Chicago, IL 60612 USA
关键词
bone marrow aspirate; bone marrow aspirate concentrate; mesenchymal stem cells; articular cartilage; knee; MESENCHYMAL STEM-CELLS; THICKNESS CHONDRAL DEFECTS; PLATELET-RICH PLASMA; COVERED MICROFRACTURE; INTERNATIONAL-SOCIETY; GROWTH-FACTORS; STROMAL CELLS; ILIAC CREST; REPAIR; TRANSPLANTATION;
D O I
10.1177/1947603517741169
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Objective. To critically evaluate the current basic science, translational, and clinical data regarding bone marrow aspirate concentrate (BMAC) in the setting of focal cartilage defects of the knee and describe clinical indications and future research questions surrounding the clinical utility of BMAC for treatment of these lesions. Design. A literature search was performed using the PubMed and Ovid MEDLINE databases for studies in English (1980-2017) using keywords, including ["bone marrow aspirate" and "cartilage"], ["mesenchymal stem cells" and "cartilage"], and ["bone marrow aspirate" and "mesenchymal stem cells" and "orthopedics"]. A total of 1832 articles were reviewed by 2 independent authors and additional literature found through scanning references of cited articles. Results. BMAC has demonstrated promising results in the clinical application for repair of chondral defects as an adjuvant procedure or as an independent management technique. A subcomponent of BMAC, bone marrow derived-mesenchymal stem cells (MSCs) possess the ability to differentiate into cells important for osteogenesis and chondrogenesis. Modulation of paracrine signaling is perhaps the most important function of BM-MSCs in this setting. In an effort to increase the cellular yield, authors have shown the ability to expand BM-MSCs in culture while maintaining phenotype. Conclusions. Translational studies have demonstrated good clinical efficacy of BMAC both concomitant with cartilage restoration procedures, at defined time points after surgery, and as isolated injections. Early clinical data suggests BMAC may help stimulate a more robust hyaline cartilage repair tissue response. Numerous questions remain regarding BMAC usage, including cell source, cell expansion, optimal pathology, and injection timing and quantity.
引用
收藏
页码:161 / 170
页数:10
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