Background

The ideal treatment of symptomatic osteochondral lesions of the knee is not clear. Both bone marrow aspirate concentrate (BMAC) and platelet-rich fibrin (PRF) utilized together with scaffolds have been shown to offer promising results. PRF has also been shown to act as a scaffold. Thus, BMAC together with PRF may be an effective treatment without the need for any other biologic scaffold.

Purpose

To report the results of the application of BMAC and PRF along with microfracture.
Study Design
Retrospective case series.
Level of evidence: IV

Methods

27 knees of 21 patients with grade III-IV cartilage defects and a follow-up of at least 24 months who underwent microfracture (MF) and application of BMAC and PRF were included. MF-BMAC-PRF alone was performed for isolated chondral defects; while anterior cruciate ligament reconstruction, medial open wedge high tibial osteotomy, meniscus surgery, and patellar realignment/stability surgery were added to the procedure when necessary. Patients were evaluated with Lysholm score, the Knee Injury and Osteoarthritis Outcome Score (KOOS), visual analog scale (VAS), and MRI imaging.

Results

The study group comprised of 13 (61.9%) males and 8 (38.1%) females with an average follow up of 28±5.9 months and age of 37.2±8.3. A total number of 37 chondral lesions were recorded on medial and lateral femoral condyles and the femoral trochlea (26 (70.3%), 1 (2.7%), and 10 (27.0%), respectively). Average values of all scores were significantly increased at final follow up. MRI examination showed early subchondral lamina regrowth and progressive maturation of repair cartilage in all defects (4 (10.8%) with moderate, 33 (89.2%) with complete or nearly-complete filling).

Conclusion

Application of BMAC and PRF combined with microfracture may be an effective treatment for symptomatic chondral lesions of the knee if malalignment, instability, and meniscal injuries are treated simultaneously.