Regenerative Medicine/Cell Therapy Approaches (BMAC, PRP, and Cellular Based Therapies)

The repair of cartilage defects has been at the forefront of regenerative medicine applications and biological-based treatment approaches for pathologies of cartilaginous tissues, and the treatment modalities have gained growing recognition in the last decades. Poor intrinsic healing potential of cartilage has led to this ongoing search for therapeutic options to improve regenerative capacities of the tissue. The most researched and commonly used regenerative medicine techniques include platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC), and cellular based therapies. Positive results have been observed for the use of PRP in conjunction with a surgical approach in the setting of focal chondral defects and suggested a higher efficacy than commonly used hyaluronic acid and corticosteroid injections. While PRP is derived from peripheral blood and therefore well accessible, BMAC is most commonly harvested from the spina iliaca anterior and posterior of the pelvis. Several studies have demonstrated that BMAC is safe and efficient in clinical use and may improve patient-reported outcome parameters and range of motion in patients with focal cartilage lesions short term. Nonoperative, cellular based therapies have demonstrated favorable results in vitro and in animal studies, while the translation of those results to clinical practice has often been problematic and its superiority to placebo treatment was not always demonstratable. At the same time operative, cellular based therapies are making the transition from cost-intensive, logistically demanding, and morbidity-rich two-stage procedures to more flexible one-step surgical application. New techniques such as recycled cartilage with allogeneic MSCs and hyaluronic acid (HA)-BMAC are facilitating this shift and offer the patient and clinicians in the field of surgical cartilage restoration a broader portfolio for validation and clinical application.