One-step surgery with multipotent stem cells and Hyaluronan-based scaffold for the treatment of full-thickness chondral defects of the knee in patients older than 45 years

By
Alberto Gobbi
Celeste Scotti
Georgios Karnatzikos
Abhishek Mudhigere
Marc Castro
Giuseppe M. Peretti
January 14, 2016
0 min

Knee Surgery, Sports Traumatology, Arthroscopy

Overview

This prospective study evaluated the efficacy of a single-stage surgical technique using bone marrow aspirate concentrate (BMAC) and a hyaluronan-based scaffold (HYAFF®11) to treat full-thickness knee cartilage defects in patients over 45 years. Results demonstrated satisfactory clinical and imaging outcomes comparable to younger patients, supporting the procedure's viability in an older population.

Background

Cartilage defects are common in middle-aged patients undergoing knee arthroscopy, with a 60% incidence reported in those aged 40 to 50 years. Traditional two-step autologous chondrocyte implantation (ACI) procedures, while effective, have limitations including cost, donor site morbidity, and reduced chondrogenic potential in older patients. Bone marrow aspirate concentrate containing mesenchymal stem cells combined with hyaluronan-based scaffolds offers a promising one-step alternative, potentially overcoming these drawbacks and promoting hyaline-like cartilage regeneration.

Data Highlights

Parameter	Study Group (>45 years)	Control Group (<45 years)
Number of patients	20	20
Mean age (years)	50.0 ± 4.1	36.6 ± 5.0
Follow-up duration (months)	48.7 ± 12.6	52.3 ± 12.2
Inclusion criteria	ICRS grade 4 cartilage lesions ≥4 cm², BMI 20-30 kg/m²	Same
Functional scores assessed	VAS, IKDC, KOOS, Tegner	Same

Key Findings

Patients over 45 years with full-thickness cartilage defects treated with BMAC and HYAFF®11 showed significant clinical improvement over 4 years.
Functional outcome measures (VAS, IKDC, KOOS, Tegner) improved comparably in both older and younger patient groups.
Radiographic and MRI evaluations demonstrated good defect filling, graft integration, and absence of adverse changes in the older cohort.
Coexisting knee pathologies were addressed concurrently without compromising cartilage repair outcomes.
The one-step procedure avoided limitations of two-step ACI, including donor site morbidity and reduced chondrogenic potential in aged chondrocytes.

Clinical Implications

The use of BMAC combined with a hyaluronan-based scaffold represents an effective single-stage surgical option for treating full-thickness cartilage defects in patients over 45 years. This approach may expand treatment eligibility to older patients who traditionally have limited options due to reduced chondrocyte potency and procedural complexity. Concurrent correction of associated knee pathologies during the same surgery can optimize outcomes.

Conclusion

Single-stage implantation of multipotent stem cells with hyaluronan scaffolds is a viable and effective treatment for full-thickness chondral defects in patients over 45 years, yielding sustained clinical and structural improvements comparable to younger populations.

References

Filardo et al. 2019 -- Single-stage surgical intervention utilizing multipotent stem cells and Hyaluronan-based scaffolds for addressing full-thickness chondral defects in individuals over 45 years of age