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BIOLOGIC ARTHOPLASTY is an innovative procedure for treating early stages arthritis with the aim of salvaging the joint, especially in relatively young patients with large chondral lesions measuring even up to 26 cm2 in size (total lesion area per patient). Biologic arthroplasty can be defined as the surgical reconstruction of the joint using biological solutions; unlike joint replacement arthroplasty it focuses on joint restoration and could be the answer to cartilage defects in younger cohorts of patients. Biologic arthroplasty could preserve the joint and significantly reverses the effects of arthritis and lower the pain, thus avoiding or delaying the joint replacement.

The principle of biologic arthroplasty is simple; we treat cartilage defects by pasting BMAC into the cartilage defect and then protect the in-growth of the neotissue with a user-friendly scaffold impermeable to cells. This technique maximizes cell-to-cell contact and provides a strong chondrogenic environment utilizing a scaffold promoting chondrogenic differentiation of MSCs and hyaline cartilage regeneration. In addition, we avoid biopsy and cell cultivation thereby reducing the cost of the treatment markedly.

The procedure is performed under anaesthesia and routine sterile preparation and surgical draping; 60ml of bone marrow aspirate is harvested from the ipsilateral iliac crest using a dedicated aspiration kit and centrifuged using a commercially available system. Then the bone marrow concentrate is activated in order to produce a sticky clot material, which is going to be implanted into the prepared cartilage defect.

After arthroscopic evaluation, the knee is approached with a mini-arthrotomy and the chondral defect is prepared and debrided with the use of curettes. Damaged cartilage is removed until a contained, shouldered defect remains, which is necessary in order to facilitate suturing the scaffold. The defect is then templated and the collagen membrane fashioned to the defect size. Finally, the prepared clot is pasted into the prepared bed of the lesion and covered with a membrane scaffold to protect the MSCs.

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Utilizing a biologic approach, we repair the articular cartilage, reconstruct the insufficient ligaments and replace an absent meniscus. In addition, we restore knee biomechanics by correcting any leg (tibiofemoral) axis malalignment, or patellofemoral maltracking. Recently we published in American Journal of Sports Medicine the medium term results of patients presenting with large chondral lesions treated with autologous bone marrow derived stem cells. All patients showed significant clinical improvement accompanied with good radiographic and histologic findings.

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