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Review
. 2021 Apr 8;22(8):3844.
doi: 10.3390/ijms22083844.

Role of Scaffolds, Subchondral, Intra-Articular Injections of Fresh Autologous Bone Marrow Concentrate Regenerative Cells in Treating Human Knee Cartilage Lesions: Different Approaches and Different Results

Jacques Hernigou  1   2 , Pascale Vertongen  2 , Joanne Rasschaert  2 , Philippe Hernigou  3
Affiliations
Review

Role of Scaffolds, Subchondral, Intra-Articular Injections of Fresh Autologous Bone Marrow Concentrate Regenerative Cells in Treating Human Knee Cartilage Lesions: Different Approaches and Different Results

Jacques Hernigou et al. Int J Mol Sci. .

Abstract

The value of bone marrow aspirate concentrates for treatment of human knee cartilage lesions is unclear. Most of the studies were performed with intra-articular injections. However, subchondral bone plays an important role in the progression of osteoarthritis. We investigated by a literature review whether joint, subchondral bone, or/and scaffolds implantation of fresh autologous bone marrow aspirate concentrated (BMAC) containing mesenchymal stem cells (MSCs) would improve osteoarthritis (OA). There is in vivo evidence that suggests that all these different approaches (intra-articular injections, subchondral implantation, scaffolds loaded with BMAC) can improve the patient. This review analyzes the evidence for each different approach to treat OA. We found that the use of intra-articular injections resulted in a significant relief of pain symptoms in the short term and was maintained in 12 months. However, the clinical trials indicate that the application of autologous bone marrow concentrates in combination with scaffolds or in injection in the subchondral bone was superior to intra-articular injection for long-term results. The tendency of MSCs to differentiate into fibrocartilage affecting the outcome was a common issue faced by all the studies when biopsies were performed, except for scaffolds implantation in which some hyaline cartilage was found. The review suggests also that both implantation of subchondral BMAC and scaffolds loaded with BMAC could reduce the need for further surgery.

Keywords: MSCs loaded scaffolds; MSCs subchondral injection; bone marrow aspirate; bone marrow concentrate; cartilage; intra-articular injection; mesenchymal stem cells; osteoarthritis; regeneration.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Comparison among synovial fluid MSCs and bone marrow iliac crest MSCs from osteoarthritis patients.
Figure 2
Figure 2
MSCs in synovial fluid derived from osteoarthritis patients. Relationship between the osteoarthritis grading and the colony number of synovial fluid MSCs per synovial fluid volume (mL).
Figure 3
Figure 3
Comparison among subchondral bone marrow MSCs and bone marrow iliac crest MSCs from osteoarthritis patients.
Figure 4
Figure 4
MSCs in subchondral bone derived from osteoarthritis patients. Relationship between the osteoarthritis grading and the colony number of subchondral bone marrow aspirate (mL).
Figure 5
Figure 5
Schematic illustration of the interaction between synovitis, cartilage and subchondral bone in OA.
See this image and copyright information in PMC

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