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Marrow Stimulation and Augmentation

  • Michael L. Redondo
  • Brian R. Waterman
  • Jack M. Bert
  • Brian J. Cole
Chapter

Abstract

Hyaline cartilage is an essential component for the form and function of articulating joints, such as the knee. With the annual incidence on the rise, there are between an estimated 30,000 and 100,000 chondral repair procedures that are performed yearly in the United States. Marrow stimulation is a commonly used technique for articular cartilage repair. Marrow stimulation involves the perforation of the subchondral bone plate, most commonly with an arthroscopic microfracture awl, for the release of marrow elements. The marrow elements fill the articular cartilage defect forming a fibrocartilage repair. Though arthroscopic microfracture is considered by some as the gold standard therapy for cartilage repair, short-term outcomes have been shown to be unreliable and unsustainable. Some experts now opine that marrow stimulation as it currently exists should be outright abandoned.

Recently, however, there has been a push for new innovations in the augmentation of the marrow stimulation techniques in order to attain more sustainable outcomes and decrease associated complications. The augmentation of microfracture via the addition of post-microfracture intra-articular platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC), and adipose-derived stem cells (ASCs) is an exciting advancement in marrow stimulation. Also, the recent introduction of the nanofracture, “rebirth” of drilling, and BioCartilage techniques offer promising technological advancement in the field of marrow stimulation. This chapter focuses on clinical indications, surgical technique, and the outcomes of marrow stimulation procedures and the augmentation of these procedures.

Keywords

Marrow stimulation Cartilage restoration Biologics Microfracture Platelet-rich plasma Bone marrow aspirate concentrate Adipose-derived mesenchymal stem cells Subchondral drilling 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Michael L. Redondo
    • 1
  • Brian R. Waterman
    • 1
  • Jack M. Bert
    • 2
  • Brian J. Cole
    • 1
  1. 1.Department of Orthopedic SurgeryCartilage Restoration Center at Rush University Medical Center Midwest Orthopedic at RushChicagoUSA
  2. 2.Minnesota Bone & Joint Specialists, LtdSt. PaulUSA

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