One Step Tissue Engineering for Cartilage Reconstruction in Severe Osteoarthritis of the Knee and Ankle: A Comprehensive Review of the Technique Resorting to Isolated BMAC or ADSCS and their Last Combination

Stefano Zanasi and Carlo Ventura
 

Abstract

An innovative clinical procedure has provided evidence that wide areas of severe cartilage defects due to osteoarthritis of the inferior limb, Kellgren stage I to III, in particular knee and ankle, can be successfully restored through transplant of human bone marrow combined with a defined human fat tissue product, like the Lipogems product. The latter is microfractured autologous human fat, containing an intact stromal vascular niche including elements of pericyte identity (Lipogems EU, http://lipogems.eu). Both are embedded within nanofabricated scaffolds with tailored-oriented architecture and fiber diameter (Chondrotissue by Biotissue, Freiburg, D http://www.biotissue.de). Such approach yields a significantly more enhanced cartilage regeneration, as compared with the rescuing effects elicited by either bone marrow or the Lipogems product alone. All these clinical outcomes are well documented by 1.5T NMR, elastosonography and in randomized histological samples showing a higher percentage of hyaline cartilage and rare fibrous tissue compared to the outcome of the single, not combined procedures. On these bases, the combined use of autologous non-expanded tissue products made of whole bone marrow and human white adipose tissue derivatives, such as the Lipogems product, can be considered as an autologous/homologous strategy for improving the natural capacity for self-healing in damaged osteo-articular tissues.

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