{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T02:58:11Z","timestamp":1792292291086,"version":"4.4.0"},"reference-count":45,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Bone and Joint Surgery"],"published-print":{"date-parts":[[2018,1,17]]},"abstract":"\n Background:<\/jats:title>\n Microfracture is commonly performed for cartilage repair but usually results in fibrocartilage. Microfracture augmented by autologous bone marrow concentrate (BMC) was previously shown to yield structurally superior cartilage repairs in an equine model compared with microfracture alone. The current study was performed to test the hypothesis that autologous BMC without concomitant microfracture improves cartilage repair compared with microfracture alone.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n Autologous sternal bone marrow aspirate (BMA) was concentrated using a commercial system. Cells from BMC were evaluated for chondrogenic potential in vitro and in vivo. Bilateral full-thickness chondral defects (15-mm diameter) were created on the midlateral trochlear ridge in 8 horses. Paired defects were randomly assigned to treatment with BMC without concomitant microfracture, or to microfracture alone. The repairs were evaluated at 1 year by in vitro assessment, arthroscopy, morphological magnetic resonance imaging (MRI), quantitative T2-weighted and ultrashort echo time enhanced T2* (UTE-T2*) MRI mapping, and histological assessment.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n Culture-expanded but not freshly isolated cells from BMA and BMC underwent cartilage differentiation in vitro. In vivo, cartilage repairs in both groups were fibrous to fibrocartilaginous at 1 year of follow-up, with no differences observed between BMC and microfracture by arthroscopy, T2 and UTE-T2* MRI values, and histological assessment (p > 0.05). Morphological MRI showed subchondral bone changes not observed by arthroscopy and improved overall outcomes for the BMC repairs (p = 0.03). Differences in repair tissue UTE-T2* texture features were observed between the treatment groups (p < 0.05).<\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n When BMC was applied directly to critical-sized, full-thickness chondral defects in an equine model, the cartilage repair results were similar to those of microfracture. Our data suggest that, given the few mesenchymal stem cells in minimally manipulated BMC, other mechanisms such as paracrine, anti-inflammatory, or immunomodulatory effects may have been responsible for tissue regeneration in a previous study in which BMC was applied to microfractured repairs. While our conclusions are limited by small numbers, the better MRI outcomes for the BMC repairs may have been related to reduced surgical trauma to the subchondral bone.<\/jats:p>\n <\/jats:sec>\n \n Clinical Relevance:<\/jats:title>\n MRI provides important information on chondral defect subsurface repair organization and subchondral bone structure that is not well assessed by arthroscopy.<\/jats:p>\n <\/jats:sec>","DOI":"10.2106\/jbjs.17.00132","type":"journal-article","created":{"date-parts":[[2018,1,18]],"date-time":"2018-01-18T17:22:55Z","timestamp":1516296175000},"page":"138-146","source":"Crossref","is-referenced-by-count":44,"title":["Minimally Manipulated Bone Marrow Concentrate Compared with Microfracture Treatment of Full-Thickness Chondral Defects"],"prefix":"10.2106","volume":"100","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4998-5846","authenticated-orcid":false,"given":"Constance R.","family":"Chu","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Stanford University, Stanford, California"},{"name":"VA Palo Alto Health Care System, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa A.","family":"Fortier","sequence":"additional","affiliation":[{"name":"College of Veterinary Medicine, Cornell University, Ithaca, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley","family":"Williams","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Stanford University, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karin A.","family":"Payne","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, University of Colorado, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taralyn M.","family":"McCarrel","sequence":"additional","affiliation":[{"name":"College of Veterinary Medicine, University of Florida, Gainesville, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan E.","family":"Bowers","sequence":"additional","affiliation":[{"name":"George Washington University, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diego","family":"Jaramillo","sequence":"additional","affiliation":[{"name":"VA Palo Alto Health Care System, Palo Alto, California"},{"name":"Nicklaus Children\u2019s Hospital, Miami, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"issue":"3-4","key":"bib1-20230901","first-page":"479","article-title":"Post-traumatic osteoarthritis: the role of accelerated chondrocyte senescence","volume":"41","author":"Martin","year":"2004","journal-title":"Biorheology."},{"issue":"5","key":"bib2-20230901","doi-asserted-by":"crossref","first-page":"1261","DOI":"10.1002\/art.10976","article-title":"The pathobiology of focal lesion development in aging human articular cartilage and molecular matrix changes characteristic of osteoarthritis","volume":"48","author":"Squires","year":"2003","journal-title":"Arthritis Rheum."},{"issue":"3","key":"bib3-20230901","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/j.knee.2007.02.001","article-title":"Articular cartilage defects: study of 25,124 knee arthroscopies","volume":"14","author":"Widuchowski","year":"2007","journal-title":"Knee."},{"issue":"11","key":"bib4-20230901","first-page":"2271","article-title":"Prevalence of knee osteoarthritis in the United States: arthritis data from the Third National Health and Nutrition Examination Survey 1991-94","volume":"33","author":"Dillon","year":"2006","journal-title":"J Rheumatol."},{"issue":"1","key":"bib5-20230901","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1002\/art.23176","article-title":"National Arthritis Data Workgroup. 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A prospective study of autologous chondrocyte implantation in patients with failed prior treatment for articular cartilage defect of the knee: results of the Study of the Treatment of Articular Repair (STAR) clinical trial","volume":"37","author":"Zaslav","year":"2009","journal-title":"Am J Sports Med."},{"issue":"4","key":"bib12-20230901","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1016\/j.arthro.2006.01.015","article-title":"Cartilage healing after microfracture in osteoarthritic knees","volume":"22","author":"Bae","year":"2006","journal-title":"Arthroscopy."},{"issue":"11","key":"bib13-20230901","doi-asserted-by":"crossref","first-page":"1180","DOI":"10.1016\/j.arthro.2006.06.020","article-title":"Is microfracture of chondral defects in the knee associated with different results in patients aged 40 years or younger?","volume":"22","author":"Kreuz","year":"2006","journal-title":"Arthroscopy."},{"issue":"11","key":"bib14-20230901","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1016\/j.joca.2006.05.003","article-title":"Results after microfracture of full-thickness chondral defects in different compartments in the knee","volume":"14","author":"Kreuz","year":"2006","journal-title":"Osteoarthritis Cartilage."},{"issue":"9","key":"bib15-20230901","doi-asserted-by":"crossref","first-page":"1911","DOI":"10.2106\/00004623-200509000-00002","article-title":"The microfracture technique for the treatment of articular cartilage lesions in the knee. 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microfracture technique","volume":"34","author":"Mithoefer","year":"2006","journal-title":"Am J Sports Med."},{"issue":"2","key":"bib19-20230901","first-page":"83","article-title":"The microfracture technique in the treatment of full-thickness chondral lesions of the knee in National Football League players","volume":"16","author":"Steadman","year":"2003","journal-title":"J Knee Surg."},{"issue":"5","key":"bib20-20230901","doi-asserted-by":"crossref","first-page":"902","DOI":"10.1177\/0363546508330137","article-title":"Increased failure rate of autologous chondrocyte implantation after previous treatment with marrow stimulation techniques","volume":"37","author":"Minas","year":"2009","journal-title":"Am J Sports Med."},{"issue":"4","key":"bib21-20230901","doi-asserted-by":"crossref","first-page":"e45","DOI":"10.5435\/JAAOS-D-16-00096","article-title":"Role of the subchondral bone in articular cartilage degeneration and 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