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Concentrated Bone Marrow Aspirate Improves Full-Thickness Cartilage Repair Compared with Microfracture in the Equine Model
Lisa A. Fortier, DVM, PhD1; Hollis G. Potter, MD2; Ellen J. Rickey, DVM3; Lauren V. Schnabel, DVM1; Li Foong Foo, MD2; Leroy R. Chong, MD2; Tracy Stokol, BVSc, PhD1; Jon Cheetham, VetMB, PhD1; Alan J. Nixon, BVSc, MS1
1 Departments of Clinical Sciences (L.A.F., L.V.S., J.C., and A.J.N.) and Population Medicine and Diagnostic Sciences (T.S.), VMC C3-181, Cornell University, Ithaca, NY 14853. E-mail address for L.A. Fortier: laf4@cornell.edu
2 MRI Division, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
3 University of Guelph, 50 Stone Road, Guelph, ON N1G 2W1, Canada
View Disclosures and Other Information
Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the Grayson-Jockey Club Research Foundation. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Investigation performed at Cornell University College of Veterinary Medicine, Ithaca, and the Hospital for Special Surgery, New York, NY

Copyright © 2010 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 Aug 18;92(10):1927-1937. doi: 10.2106/JBJS.I.01284
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Abstract

Background: 

The purpose of this study was to compare the outcomes of treatment with bone marrow aspirate concentrate, a simple, one-step, autogenous, and arthroscopically applicable method, with the outcomes of microfracture with regard to the repair of full-thickness cartilage defects in an equine model.

Methods: 

Extensive (15-mm-diameter) full-thickness cartilage defects were created on the lateral trochlear ridge of the femur in twelve horses. Bone marrow was aspirated from the sternum and centrifuged to generate the bone marrow concentrate. The defects were treated with bone marrow concentrate and microfracture or with microfracture alone. Second-look arthroscopy was performed at three months, and the horses were killed at eight months. Repair was assessed with use of macroscopic and histological scoring systems as well as with quantitative magnetic resonance imaging.

Results: 

No adverse reactions due to the microfracture or the bone marrow concentrate were observed. At eight months, macroscopic scores (mean and standard error of the mean, 9.4 ± 1.2 compared with 4.4 ± 1.2; p = 0.009) and histological scores (11.1 ± 1.6 compared with 6.4 ± 1.2; p = 0.02) indicated improvement in the repair tissue in the bone marrow concentrate group compared with that in the microfracture group. All scoring systems and magnetic resonance imaging data indicated that delivery of the bone marrow concentrate resulted in increased fill of the defects and improved integration of repair tissue into surrounding normal cartilage. In addition, there was greater type-II collagen content and improved orientation of the collagen as well as significantly more glycosaminoglycan in the bone marrow concentrate-treated defects than in the microfracture-treated defects.

Conclusions: 

Delivery of bone marrow concentrate can result in healing of acute full-thickness cartilage defects that is superior to that after microfracture alone in an equine model.

Clinical Relevance: 

Delivery of bone marrow concentrate to cartilage defects has the clinical potential to improve cartilage healing, providing a simple, cost-effective, arthroscopically applicable, and clinically effective approach for cartilage repair.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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