Cartilage injuries are one of the greatest therapeutic challenges for orthopedic surgeons. The management of these lesions remains complex and with numerous therapeutic options, being a difficult pathology, despite the numerous treatments that have been tried.
For years, the debridement of the lesion and the curettage and stimulation of the bone marrow with perforations (microfractures) have been the Gold-standard technique for its treatment, although with despair and less hopeful results in lesions larger than 1.5cm2.
The development and introduction of biological therapies are undoubtedly one of the treatments where more hope has been placed to resolve and optimize the results of chondral lesions.
Nowadays, these treatments have obtained hopeful results, but they are still waiting to objectify, combine, and determine the resulting products to be used, both in the field of the so-called PRP’s (platelet-rich plasma), where there is a wide variety of products results that can hardly homogenize the studies carried out and compare their conclusions, as in the field of cell therapy, from cell concentrates (bone marrow, fat-derived cells, …) to expansion and cell culture.
In addition to the complexity of biological treatments, the diversity of lesions, the differences in the size of the lesion, the age of the patients and their functional requirements are some of the variables that can influence the results of these treatments.
One of these last treatments applied to the cartilage is the bone marrow concentrate. Its use in avascular necrosis of the femoral head has been widely valued for years [Citation1].
However, its application in cartilage lesions has been the subject of few studies that, although they seem to show encouraging results [Citation2, Citation3], there are still no large studies with sufficient scientific evidence.
The study published in the Journal of Investigative Surgery [Citation4] shows an interesting work with a long series of patients and an adequate follow-up that, despite not being a clinical trial, performs a comparative study of treatment with bone marrow concentrate in a group of patients operated hip arthroscopy with a historical series to which the same procedure was performed, and may offer sufficient evidence to demonstrate a positive result.
Hip arthroscopy in cases of femoroacetabular impingement is undoubtedly a treatment proven to be effective, but not without limitations with the presence of cartilage lesions [Citation5]. Undoubtedly, the benefit of the resolution of the impingement is limited in cases of cartilaginous lesions of sufficient degree to reduce the joint space below 2 mm. This cartilaginous involvement is currently considered the main limitation and one of the major prognostic factors of treatment failure in this type of hips [Citation6].
In this line and from my point of view, I consider it important to highlight the efforts of many scientists and professionals with both public and private exercise that, without financial support from government institutions, but originated from personal effort and scientific encouragement, they manage to carry out interesting studies like the present one.
Evidence-based medicine leads us to publish clinical trials and studies at the highest level to demonstrate its evidence, but administrative difficulties, ethical conflicts and above all economic difficulties are a brake on its realization, and that is why the realization of Studies such as series of cases with level 4 of evidence, or studies of level 3 comparing historical series are a valid resource and of less difficulty, both administrative and economic.
A greater facility and help to carry out studies of the highest level would be followed by a greater number of studies of level 1 and 2, which would contribute without doubt to a greater knowledge of these therapies to achieve the greatest benefit for our patients.
Declaration of interest
The author has no competing interests to declare.
REFERENCES
- Hernigou P, Trousselier M, Roubineau F, et al. Stem cell therapy for the treatment of hip osteonecrosis: a 30-year review of progress. Clin Orthop Surg. 2016;8(1):1–8.
- Garwood ER, et al. Percutaneous ultrasound-guided musculoskeletal applications of autologous bone marrow aspirate concentrate: preliminary experience from a single institution. Ultrasound Q. 2018;34(4):278–284.
- Rodriguez-Fontan F, et al. Early clinical outcomes of intra-articular injections of bone marrow aspirate concentrate for the treatment of early osteoarthritis of the hip, and knee: a Cohort Study. PM R. 2018;10(12):1353–1359.
- Seijas R, Rivera E, Rubio-Zaragoza M, et al. Outcomes at 2 years follow-up after hip arthroscopy combining bone marrow concentrate. J Invest Surg. 2019;33(7):655–663.
- McCarthy JC. Hip arthroscopy: when it is and when it is not indicated. Instr Course Lect. 2004;53:615–621.
- Domb BG, Martin TJ, Gui C, et al. Predictors of clinical outcomes after hip arthroscopy: a prospective analysis of 1038 patients with 2-year follow-up. Am J Sports Med. 2018;46(6):1324–1330.