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Articular cartilage is a highly specialized tissue of diarthrodial joints, which is responsible for load bearing as well as for providing a smooth gliding interface for a joint. It is extremely strong, but very flexible and elastic. The function of articular cartilage is to reduce friction at joints by providing a sliding area which facilitates bone movement. Articular cartilage has a very limited healing potential; therefore, once injury occurs it is essential to restore a smooth surface which enables smooth motion of bone and the ability to withstand extreme amounts of pressures.

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Cartilage repair procedures play an integral role in the treatment of cartilage lesions and serve as a therapeutic bridge between debridement and arthroplasty. Various treatment options have been tried to aid the healing of articular cartilage. Traditional surgical techniques that are palliative (i.e. lavage, chondroplasty) only provide symptomatic pain relief with no actual hyaline tissue formation. Bone marrow stimulation techniques (i.e. microfracture, drilling) produce fibrocartilaginous tissue that will degenerate with time. Long-term results of microfracture are not favourable20. Autologous osteochondral grafts and mosaicplasty restore normal cartilage tissue, but the application is restricted to small defects and there are some concerns about donor site morbidity. Autologous chondrocyte implantation (ACI) which was first introduced by Lars Peterson et al.6 is considered an effective procedure for cartilage defects of the knee restoring hyaline-like cartilage tissue, which is mechanically and functionally stable at long-term follow-up4,38,39.

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We follow biological approach for the treatment of cartilage lesions and the reconstruction of the elements of a joint. We utilize bone marrow aspirate concentrated cells (BMAC), which contain multipotent mesenchymal stem cells (MSCs) and growth factors (GF), as an alternative to regenerate cartilage tissue. With our technique we avoid a two-step surgery for cartilage biopsy and subsequent chondrocyte cell cultivation, as occurs in autologous chondrocyte implantation technique, with a significant reduction of the cost of the total procedure. MSCs have a high proliferation and differentiation potential into chondrogenic cells: once MSCs are cultured in the appropriate microenvironment, they can differentiate to chondrocytes and form cartilage.