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World J Orthop. Jul 18, 2012; 3(7): 101-108
Published online Jul 18, 2012. doi: 10.5312/wjo.v3.i7.101
Establishing proof of concept: Platelet-rich plasma and bone marrow aspirate concentrate may improve cartilage repair following surgical treatment for osteochondral lesions of the talus
Niall A Smyth, Christopher D Murawski, Amgad M Haleem, Charles P Hannon, Ian Savage-Elliott, John G Kennedy
Niall A Smyth, Christopher D Murawski, Amgad M Haleem, Charles P Hannon, Ian Savage-Elliott, John G Kennedy, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY 10021, United States
Author contributions: Smyth NA was the primary author of the manuscript; Murawski CD, Haleem AM, Hannon CP, and Savage-Elliott I made equal contributions to writing and editing of the manuscript; Kennedy JG was the senior author and made critical contributions to the manuscript and provided the final approval.
Correspondence to: Niall A Smyth, MD, Department of Orthopaedic Surgery, Hospital for Special Surgery, 523 East 72nd Street, Ste 514, New York, NY 10021, United States. smythn@hss.edu
Telephone: +1-646-7978880 Fax: +1-646-7978966
Received: March 26, 2012
Revised: June 5, 2012
Accepted: July 10, 2012
Published online: July 18, 2012
Abstract

Osteochondral lesions of the talus are common injuries in the athletic patient. They present a challenging clinical problem as cartilage has a poor potential for healing. Current surgical treatments consist of reparative (microfracture) or replacement (autologous osteochondral graft) strategies and demonstrate good clinical outcomes at the short and medium term follow-up. Radiological findings and second-look arthroscopy however, indicate possible poor cartilage repair with evidence of fibrous infill and fissuring of the regenerative tissue following microfracture. Longer-term follow-up echoes these findings as it demonstrates a decline in clinical outcome. The nature of the cartilage repair that occurs for an osteochondral graft to become integrated with the native surround tissue is also of concern. Studies have shown evidence of poor cartilage integration, with chondrocyte death at the periphery of the graft, possibly causing cyst formation due to synovial fluid ingress. Biological adjuncts, in the form of platelet-rich plasma (PRP) and bone marrow aspirate concentrate (BMAC), have been investigated with regard to their potential in improving cartilage repair in both in vitro and in vitro settings. The in vitro literature indicates that these biological adjuncts may increase chondrocyte proliferation as well as synthetic capability, while limiting the catabolic effects of an inflammatory joint environment. These findings have been extrapolated to in vitro animal models, with results showing that both PRP and BMAC improve cartilage repair. The basic science literature therefore establishes the proof of concept that biological adjuncts may improve cartilage repair when used in conjunction with reparative and replacement treatment strategies for osteochondral lesions of the talus.

Keywords: Osteochondral lesion; Cartilage repair; Platelet-rich plasma; Bone marrow aspirate concentrate