Sciarretta Fabio Valerio
Clinica Nostra Signora della Mercede
Italy
Title: A novel chondral defect repair strategy: biologic resurfacing through innovative bone marrow concentration system
Biography
Biography: Sciarretta Fabio Valerio
Abstract
While performing an arthroscopy of the knee, cartilage injuries, of any grade, have a whole reported frequency between 57.3% and 66% of cases. These numbers make it clear that, more and more, young adults under the age of 65 years, present with an advanced disease to joint cartilage. in recent years, have increasingly found their way the regenerative medicine therapies, which allow to correct alterations of the biological basis of the disease's process, rather than addressing only the symptoms. Orthobiologics are based on the use of mesenchymal stem cells that can mainly be obtained from bone marrow or adipose tissue. Since no surgical technique has still been proven to be the gold standard of chondral repair, in order to increase the results of the recently developed single stage chondral repair techniques delivering to defect site a larger number of multipotent cells to improve defect filling and repair, the augmented single stage procedures have been introduced. These techniques represent an evolution of the standard AMIC procedure, where a collagen membrane is used to repair and resurface chondral defects. In the augmented techniques the use of PRP or bone marrow concentrate is added to the collagen membrane. In this paper we present the initial experience with a new system for bone marrow aspiration and concentration, perfectly adapting to the timing of one step cartilage repair AMIC technique. The surgical technique steps are: chondral defect debridement, bone marrow iliac crest aspiration through power driven aspiration cannula, defect's sizing through aluminum template use, microfractures, collagen membrane sizing and soaking with bone marrow concentrate obtained through completely closed centrifugation and, finally, closure of the chondral defect with collagen membrane, bone marrow concentrate and fibrin glue. The surgical technique is safe, lasts 15-20 minutes, is completed all inside the OR and doesn't need cellular expansion. Randomized controlled clinical trials will confirm the results.