Heng Christian Hwee Yee, Lee Yee Han Dave
Department of Orthopaedic Surgery, Changi General Hospital, Singapore.
Video J Sports Med. 2021 Jun 15;1(3):26350254211008190. doi: 10.1177/26350254211008190. eCollection 2021 May-Jun.
Injectable scaffold augmentation has been gaining traction as a promising modality for single-stage cartilage repair. It involves the use of a biological scaffold that augments microfracture techniques by aiding in clot stabilization and maturation. The scaffold provides a matrix that helps with mesenchymal stem cell (MSC) retention and encourages differentiation along a chondrogenic lineage. Bone marrow aspirate concentrate (BMAC) has also been proposed as an alternative source of MSCs to microfracture, and it can potentially avoid the pitfalls of microfracture techniques.
Injectable scaffold augmentation to microfracture techniques are recommended in lesions >4 cm, as long-term follow-up has shown increasing failure over time with microfracture alone.
We describe a technique of autologous matrix-induced chondrogenesis using CartiFill, a porcine-derived type 1 collagen scaffold, combined with BMAC as a source of MSCs (avoiding the use of microfracture).
Injectable scaffold augmentation has been shown in recent studies to lead to better radiological fill, higher quality of histological repair, and better clinical outcomes as compared with microfracture alone. These injectable scaffolds have the versatility to be used on lesions which have traditionally been considered difficult to address, such as vertical or inverted lesions. Moreover, the use of scaffolds allows the repair to be further augmented with BMAC which provides a source of MSCs without the need to perform microfracture and perforate the subchondral bone.
DISCUSSION/CONCLUSION: Scaffold augmentation is a promising technique that improves upon the results of conventional microfracture repair by allowing augmentation with BMAC, as well as giving surgeons the versatility to apply the scaffold on vertical/inverted lesions. BMAC is also a viable alternative source of MSCs for cartilage repair.
可注射支架增强术作为一种有前景的单阶段软骨修复方式正逐渐受到关注。它涉及使用生物支架，通过辅助血凝块稳定和成熟来增强微骨折技术。该支架提供一种基质，有助于间充质干细胞（MSC）的保留，并促进其沿软骨形成谱系分化。骨髓抽吸浓缩物（BMAC）也被提议作为微骨折中MSC的替代来源，它有可能避免微骨折技术的缺陷。
对于大于4厘米的损伤，建议采用可注射支架增强微骨折技术，因为长期随访显示，单纯微骨折随时间推移失败率会增加。
我们描述了一种使用CartiFill（一种猪源I型胶原蛋白支架）结合BMAC作为MSC来源（避免使用微骨折）的自体基质诱导软骨形成技术。
最近的研究表明，与单纯微骨折相比，可注射支架增强术能带来更好的放射学填充、更高质量的组织学修复以及更好的临床结果。这些可注射支架具有通用性，可用于传统上认为难以处理的损伤，如垂直或倒置损伤。此外，使用支架允许通过BMAC进一步增强修复，BMAC提供了MSC来源，而无需进行微骨折和穿透软骨下骨。
讨论/结论：支架增强术是一种有前景的技术，通过允许使用BMAC增强以及让外科医生能够将支架应用于垂直/倒置损伤，改进了传统微骨折修复效果。BMAC也是软骨修复中一种可行的MSC替代来源。
