Clin Sports Med
· 2025 Oct · PMID 41101903
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Publisher ↗
The utilization of bone marrow and concentrated bone marrow aspirate (cBMA) to treat musculoskeletal conditions is based on the principle of promoting a therapeutic biologic environment through delivering mesenchymal str...The utilization of bone marrow and concentrated bone marrow aspirate (cBMA) to treat musculoskeletal conditions is based on the principle of promoting a therapeutic biologic environment through delivering mesenchymal stromal cells along with numerous anti-inflammatory and immunomodulating mediators. As such, the use of cBMA as a treatment approach for osteoarthritis of the knee has gained interest. Recent clinical evidence suggests that the application of cBMA for varying severities of knee osteoarthritis is predominately symptom-modifying, with limited evidence suggesting that there may exist an early disease-modifying effect through native tissue regeneration.
Chiari Gaggia GMM, Conte P, Anzillotti G
… +3 more, Lipina M, Di Matteo B, Kon E
Clin Sports Med
· 2025 Oct · PMID 41101902
·
Publisher ↗
This article reviews the efficacy and safety of biological therapies-platelet-rich plasma (PRP), platelet-poor plasma (PPP), and autologous conditioned serum (ACS)-for treating knee osteoarthritis (KOA). PRP, rich in gro...This article reviews the efficacy and safety of biological therapies-platelet-rich plasma (PRP), platelet-poor plasma (PPP), and autologous conditioned serum (ACS)-for treating knee osteoarthritis (KOA). PRP, rich in growth factors, shows mixed results, with its effects dependent on preparation methods. PPP offers a lower risk of inflammation, and ACS, high in anti-inflammatory cytokines, reduces KOA symptoms. The review highlights the need for standardized protocols and further research to establish the optimal use of these therapies, suggesting they may offer promising alternatives to traditional KOA treatments.
Clin Sports Med
· 2025 Oct · PMID 41101901
·
Publisher ↗
Osteoarthritis is a debilitating joint disease that affects the knee joint most frequently. Conservative treatment options aim to alleviate symptoms of pain while improving function and delaying the need for operative in...Osteoarthritis is a debilitating joint disease that affects the knee joint most frequently. Conservative treatment options aim to alleviate symptoms of pain while improving function and delaying the need for operative intervention. Corticosteroid injections and hyaluronic acid injections have become the mainstay of conservative treatment options. This article reviews the efficacy and safety of both injections, as well as their utility in the treatment of knee osteoarthritis.
Cartilage lesions of the hip are frequently encountered in the setting of multiple concomitant hip pathologies. For patients with symptoms refractory to comprehensive nonoperative management, numerous surgical treatments...Cartilage lesions of the hip are frequently encountered in the setting of multiple concomitant hip pathologies. For patients with symptoms refractory to comprehensive nonoperative management, numerous surgical treatments are available. To date, the ideal management strategy for hip chondral defects remains controversial, with patients best suited by an individualized approach accounting for the lesion being treated as well as any potentially modifiable underlying factors such as femoroacetabular impingement or dysplasia. Studies on the treatment of hip chondral defects continue to be published at a seemingly exponential rate, highlighting the evolution of treatment strategies for these patients.
Osteochondral lesions of the talus (OLTs) pose significant treatment challenges in athletes due to the unique characteristics of the osteochondral unit and high functional demands. This systematic review and meta-analysi...Osteochondral lesions of the talus (OLTs) pose significant treatment challenges in athletes due to the unique characteristics of the osteochondral unit and high functional demands. This systematic review and meta-analysis, covering literature from January 1990 to April 2024, compares surgical techniques for treating OLTs. Data on surgical details, return-to-sport (RTS) rates, clinical scores, and demographics were analyzed. The mean age was 34.5 years, body mass index 25.7 kg/m, and lesion size 111.5 mm, with a follow-up of 4.7 years. No significant differences were found in postoperative clinical scores among techniques. Bone marrow stimulation showed an RTS rate of 83.3% and RTS to pre-injury level of 52.7%.
The meniscus of the human knee was once thought of as a vestigial structure and oftentimes excised in the treatment of meniscal pathology. As further knowledge was gained as to the vital role these structures play in nor...The meniscus of the human knee was once thought of as a vestigial structure and oftentimes excised in the treatment of meniscal pathology. As further knowledge was gained as to the vital role these structures play in normal knee health and biomechanics, a movement developed to make every attempt at preserving them in the face of trauma or degeneration. For meniscal deficient knees, allograft transplantation is an accepted treatment for pain and dysfunction with long-term data showing favorable outcomes. Novel meniscus prostheses and scaffolds show promise, but further investigation proving efficacy is necessary prior to their widespread implementation.
High tibial osteotomy shifts the weight-bearing axis of the lower limb away from a diseased medial compartment. It has been associated with high rates of return to work and sport and high midterm to long-term survivorshi...High tibial osteotomy shifts the weight-bearing axis of the lower limb away from a diseased medial compartment. It has been associated with high rates of return to work and sport and high midterm to long-term survivorship. However, appropriate patient selection is paramount for achieving optimal outcomes. Factors that can affect outcomes include severity of medial cartilage damage, age, body mass index, and smoking status.
Knee articular cartilage defects present significant challenges in orthopedic practice, impacting patient's quality-of-life akin to severe osteoarthritis. This review explores current surgical strategies, focusing on the...Knee articular cartilage defects present significant challenges in orthopedic practice, impacting patient's quality-of-life akin to severe osteoarthritis. This review explores current surgical strategies, focusing on the efficacy and outcomes of 3 prominent matrices in the form of osteochondral scaffolds: Autologous Matrix-Induced Chondrogenesis or AMIC with Chondro-Gide (Geistlich), MaioRegen (Finceramica), and Agili-C (Smith&Nephew, CartiHeal). AMIC technique combines microfracture with a porcine-derived collagen scaffold, showing sustained long-term clinical improvements and outperforming microfracture alone. Nonetheless, lesion characteristics and patient demographics are the keys for optimal knee cartilage repair outcomes.
Chondral lesions have improved clinical outcomes when the cartilage layer is restored with hyaline-like cartilage as opposed to fibrocartilage. Restoration of hyaline-like cartilage in chondral defects has been achieved...Chondral lesions have improved clinical outcomes when the cartilage layer is restored with hyaline-like cartilage as opposed to fibrocartilage. Restoration of hyaline-like cartilage in chondral defects has been achieved using autologous chondrocyte implantation and matrix-associated autologous chondrocyte implantation for larger chondral defects (>4 cm) but requires a 2-stage surgical approach. Single-stage allograft options such as cryopreserved viable osteochondral allograft, viable cartilage allograft matrix, and juvenile articular cartilage allow for single-stage surgical treatment of these cartilage lesions with good short-term to mid-term results in clinical trials.
Osteochondral allograft transplantation in the knee is an effective procedure to treat isolated and complex pathologies of articular cartilage. Osteochondral allograft transplantation has an overall high graft survivorsh...Osteochondral allograft transplantation in the knee is an effective procedure to treat isolated and complex pathologies of articular cartilage. Osteochondral allograft transplantation has an overall high graft survivorship, ranging between 78% to 91% at 10 years. Patients report significant improvements in pain and function and high satisfaction.
Autologous minced cartilage implantation (AMCI) is an innovative orthopedic technique for repairing and regenerating damaged cartilage using minced autologous cartilage fragments. This method minimizes immune rejection r...Autologous minced cartilage implantation (AMCI) is an innovative orthopedic technique for repairing and regenerating damaged cartilage using minced autologous cartilage fragments. This method minimizes immune rejection risks and tries to promote natural healing, leading to improved long-term outcomes. AMCI can be manufactured using a commercially available kit, in a single step, which has reported significant pain reduction and enhanced joint stability, allowing them to resume daily activities. The minimally invasive procedure, quick recovery, and high patient satisfaction make AMCI a promising option. However, successful outcomes depend on patient selection and defect characteristics.
Chondral and osteochondral lesions are common after joint trauma and various cartilage lesion repair techniques have been explored. One such technique is autologous chondrocyte implantation (ACI). Most reports on ACI are...Chondral and osteochondral lesions are common after joint trauma and various cartilage lesion repair techniques have been explored. One such technique is autologous chondrocyte implantation (ACI). Most reports on ACI are on the 1st and 2nd generation ACI with cells in suspension under a sutured membrane. Today's 3rd generation ACI is opening up possibility for arthroscopic implantations. Arthroscopic surgery reduces patient morbidity and also accelerates the rehab process. Fourth generation ACI, a one stage procedure, has just recently attracted interest. This article reviews the indications, the technical considerations, and clinical findings, and addresses many of the questions raised about ACI.
Microfracture (MF) treats small full-thickness cartilage defects in the knee by creating subchondral bone perforations to stimulate cartilage regeneration. Despite its popularity, MF produces fibrocartilage with inferior...Microfracture (MF) treats small full-thickness cartilage defects in the knee by creating subchondral bone perforations to stimulate cartilage regeneration. Despite its popularity, MF produces fibrocartilage with inferior properties to native hyaline cartilage, leading to midterm clinical deterioration. Microfracture plus (MFplus) aims to enhance outcomes by integrating scaffolds and orthobiologics. This scoping review evaluates MF and MFplus, focusing on clinical, MRI, and histologic outcomes. Techniques examined include MF with porcine collagen membranes, hyaluronic acid-based matrices, and orthobiologics like platelet-rich plasma, bone marrow aspirate concentrate, and adipose tissue-derived stromal cells.
Focal articular cartilage injuries of the knee are common and can be challenging to manage. To appropriately counsel and indicate patients for treatment, having a complete understanding of a patient's symptoms, goals for...Focal articular cartilage injuries of the knee are common and can be challenging to manage. To appropriately counsel and indicate patients for treatment, having a complete understanding of a patient's symptoms, goals for treatment, activity level, physical examination, and imaging findings is critical. Conservative measures, including activity modification, anti-inflammatory medication, physical therapy, and injections can result in substantial symptom relief. Reoperation after cartilage procedures is common and should be discussed preoperatively. Similarly, a successful outcome may be associated with incomplete pain relief or functional return. Treatment paradigms will continue to evolve as techniques improve and novel technologies are investigated.
Imaging plays an important role in clinical and surgical decision making in patients with cartilage derangements. Expert consensus statements and classification systems are in place to standardize the MRI reporting of ar...Imaging plays an important role in clinical and surgical decision making in patients with cartilage derangements. Expert consensus statements and classification systems are in place to standardize the MRI reporting of articular cartilage derangements and highlight the important imaging findings to report. This article reviews MRI evaluation of articular cartilage through a discussion of major imaging classification systems and common cartilage disorders of the lower and upper extremity joints.
Bracing options for the therapeutic and preventative treatment of cartilage injury and osteoarthrosis have traditionally been understudied and underutilized due to poor patient compliance and a lack of published clinical...Bracing options for the therapeutic and preventative treatment of cartilage injury and osteoarthrosis have traditionally been understudied and underutilized due to poor patient compliance and a lack of published clinical efficacy data. However, recent advancements in 3-dimensional printing, biomechanical analysis of the joint, and dynamic joint unloading technologies are re-establishing bracing as an effective, low-cost, and low-risk non-surgical treatment option. When combined with other operative and non-operative methods in a data-based approach, bracing may offer improved outcomes in therapeutic, palliative, and prophylactic applications for cartilage disease and injury.
Human umbilical cord-derived mesenchymal stem cells (hUC-MSCs) are being investigated as a potential treatment of osteoarthritis (OA), the most prevalent degenerative joint disease worldwide. Conversely, concerns about i...Human umbilical cord-derived mesenchymal stem cells (hUC-MSCs) are being investigated as a potential treatment of osteoarthritis (OA), the most prevalent degenerative joint disease worldwide. Conversely, concerns about its paracrine effect are drawing attention to noncellular alternatives such as secretomes and exosomes. The potential of hUC-MSCs, exosomes, and secretomes in cartilage regeneration is reported through a systematic evaluation of 44 publications, including investigations on humans and animals. Even with promising results, more research is necessary to eliminate bias and validate findings for use in clinical therapeutic settings.
Exosomes and extracellular vesicles (EVs) are an emerging technology in the field of orthobiology. This "cell-free" cell therapy can bring the potential of cell therapy into orthopedic surgery applications without the ha...Exosomes and extracellular vesicles (EVs) are an emerging technology in the field of orthobiology. This "cell-free" cell therapy can bring the potential of cell therapy into orthopedic surgery applications without the hassle of cell therapy logistics. However, the dream of producing an off-the-shelf regenerative therapy drug faces challenges, such as optimization of dosage, frequency, and consistency of therapy efficacy. In this review, we look at the role of exosomes and EVs in treating cartilage diseases, discuss the efficacy of these treatment modalities in the preclinic settings, and summarize current clinical state and challenges for this novel therapy in cartilage repair.