• avascular necrosis
• hip
• orthobiologics
• osteonecrosis
• regenerative therapies

• Humans
• Femur Head Necrosis/therapy
• Femur Head Necrosis/surgery
• Arthroplasty, Replacement, Hip
• Platelet-Rich Plasma
• Survival Analysis
• Mesenchymal Stem Cell Transplantation

• Avascular necrosis of the femoral head
• Bone grafting
• Core decompression
• Platelet-rich plasma

• Humans
• Femur Head Necrosis/surgery
• Femur Head Necrosis/therapy
• Platelet-Rich Plasma
• Retrospective Studies
• Female
• Male
• Bone Transplantation/methods
• Adult
• Decompression, Surgical/methods
• Middle Aged
• Treatment Outcome
• Combined Modality Therapy
• Follow-Up Studies
• Young Adult
• Arthroplasty, Replacement, Hip/methods

• Project No. 22-321-32-13 Science and Technology Plan Project of Shenyang City
• Project No. 2024 Science and Technology Fund of the Education Department of Liaoning Province
• Project JYTMS20231396 Liaoning Provincial Department of Education Fund

• Core decompression
• Femoral head
• Osteonecrosis
• Stem cell

• Humans
• Femur Head Necrosis/therapy
• Male
• Adult
• Mesenchymal Stem Cell Transplantation/methods
• Female
• Mesenchymal Stem Cells/cytology
• Mesenchymal Stem Cells/metabolism
• Retrospective Studies
• Bone Marrow Cells/cytology
• Treatment Outcome
• Cells, Cultured
• Middle Aged
• Transplantation, Autologous
• Decompression, Surgical/methods

• No. 22D0801L1 the Ministry of Science and ICT, the Ministry of Health & Welfare
• No. 22C0604L1 the Ministry of Science and ICT, the Ministry of Health & Welfare
• the Ministry of Science and ICT, the Ministry of Health & Welfare

• Graft healing
• Graft maturation
• Laxity
• MRI

• Humans
• Prospective Studies
• Bone Marrow
• Anterior Cruciate Ligament Reconstruction/methods
• Platelet-Rich Plasma
• Biological Products
• Anterior Cruciate Ligament Injuries/diagnostic imaging
• Anterior Cruciate Ligament Injuries/surgery

• MOHW107-TDU-B-212-123006 Ministry of Health and Welfare
• MOHW108-TDU-B-212-133006 Ministry of Health and Welfare
• MOST 111-2314-B-037-057- Ministry of Science and Technology, Taiwan
• NSTC 112-2314-B-037-100-MY2 Ministry of Science and Technology, Taiwan
• H-112-002 Kaohsiung Municipal Siaogang Hospital, Taiwan
• KMU-TC112A02 Kaohsiung Medial University, Taiwan

Bone marrow-derived mesenchymal stem cells obtained from bone marrow aspirate concentrate (BMAC) with platelet-rich plasma (PRP), has been used as an adjuvant to hip decompression. Early results have shown promise for hip preservation in patients with osteonecrosis (ON) of the femoral head. The purpose of the current study is to examine the mid-term outcome of this treatment in patients with precollapse corticosteroid-induced ON of the femoral head.

In all, 22 patients (35 hips; 11 males and 11 females) with precollapse corticosteroid-induced ON of the femoral head underwent hip decompression combined with BMAC and PRP. Mean age and BMI were 43 years (SD 12) and 31 kg/m² (SD 6), respectively, at the time of surgery. Survivorship free from femoral head collapse and total hip arthroplasty (THA) and risk factors for progression were evaluated at minimum five-years of clinical follow-up with a mean follow-up of seven years (5 to 8).

Survivorship free from femoral head collapse and THA for any reason was 84% and 67% at seven years postoperatively, respectively. Risk factors for conversion to THA included a high preoperative modified Kerboul angle (grade 3 or 4) based on preoperative MRI (hazard ratio (HR) 3.96; p = 0.047) and corticosteroid use at the time of decompression (HR 4.15; p = 0.039). The seven-year survivorship for patients with grade 1 or 2 Kerboul angles for conversion to THA for articular collapse, and THA for any reason, were 96% and 72%, respectively, versus THA for articular collapse and THA for any reason in patients with grade 3 or 4 Kerboul angles of 40% (p = 0.003) and 40% (p = 0.032).

At seven years, hip decompression augmented with BMAC and PRP provided a 67% survivorship free from THA in patients with corticosteroid-induced ON. Ideal candidates for this procedure are patients with low preoperative Kerboul angles and can stop corticosteroid treatment prior to decompression.

Cite this article: Bone Jt Open 2021;2(11):926–931.

• Bone marrow derived stem cells
• Femoral head
• Hip preservation
• MRI
• Osteonecrosis
• bone marrow
• bone marrow aspirate concentrate (BMAC)
• corticosteroid-induced osteonecrosis of the femoral head
• corticosteroids
• femoral head
• femoral head collapse
• hips
• platelet-rich plasma (PRP)
• total hip arthroplasty (THA)

• autologous bone marrow
• multipotent mesenchymal stromal cells
• osteonecrosis
• regenerative therapy

• PhD Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM) PhD studentship.

Osteoarthritis (OA) is a progressive degenerative disease that manifests as pain and inflammation and often results in total joint replacement. There is significant interest in understanding how intra-articular injections made from autologous blood or bone marrow could alleviate symptoms and potentially intervene in the progression of the disease. There is in vitro an in vivo evidence that suggests that these therapies, including platelet-rich plasma (PRP), autologous anti-inflammatories (AAIs), and concentrated bone marrow aspirate (cBMA), can interrupt cartilage matrix degradation driven by pro-inflammatory cytokines. This review analyzes the evidence for and against inclusion of white blood cells, the potential role of platelets, and the less studied potential role of blood plasma when combining these components to create an autologous point-of-care therapy to treat OA. There has been significant focus on the differences between the various autologous therapies. However, evidence suggests that there may be more in common between groups and perhaps we should be thinking of these therapies on a spectrum of the same technology, each providing significant levels of anti-inflammatory cytokines that can be antagonists against the inflammatory cytokines driving OA symptoms and progression. While clinical data have demonstrated symptom alleviation, more studies will need to be conducted to determine whether these preclinical disease-modifying findings translate into clinical practice.

• autologous anti-inflammatory
• concentrated bone marrow aspirate
• intra-articular injection
• mechanism of action
• osteoarthritis
• platelet-rich plasma

• Anti-Inflammatory Agents/therapeutic use
• Humans
• Injections, Intra-Articular
• Knee Joint/immunology
• Knee Joint/pathology
• Osteoarthritis, Knee/immunology
• Osteoarthritis, Knee/pathology
• Osteoarthritis, Knee/therapy
• Platelet-Rich Plasma
• Point-of-Care Systems

The use of orthobiologics as a novel therapy for the treatment of numerous musculoskeletal disorders has increased considerably over the past decade. Currently, there are multiple alternatives available as suitable treatments; however, the use of autologous blood-derived products such as platelet-rich plasma (PRP), bone marrow aspirate (BMA) and BMA concentrate (BMAC), specifically, is expanding. Although many investigations attempted to demonstrate the effectiveness of these therapies, even with positive results, the literature lacks standardized protocols and overall accuracy in study designs, which leads to variance and difficulty in reproducibility of protocols. The efficacy of PRP for the treatment of cartilage, bone and muscle tissues is well known. Although BMAC has generated optimistic results for the same purposes, its applicability in clinical trials is still relatively recent when compared to PRP. Both products demonstrate the potential to set forth reparative processes, each in their own distinct mechanism. The combination of these biological products has been previously proposed, yet little is known about their synergism. Evidence indicates that growth factor, cytokine, and chemokine profiles seen in both PRP and BMAC vary but are likely to work synergistically to enhance musculoskeletal healing. BMAC products seem to work well without PRP; however, the addition of PRP to BMAC has been shown to act as a rich and natural source of culture medium for stem cells located either peripherally or in the bone marrow itself. Nevertheless, additional variables associated with the use of BMAC and PRP in orthopedics must be further evaluated in order to consolidate the efficacy of this therapeutic strategy.

• Orthobiologics
• Platelet-rich plasma
• Bone-marrow aspirate
• Regenerative medicine
• Musculoskeletal diseases
• Stem cells

Osteonecrosis (ON) is an acquired debilitating skeletal disorder, which is caused by a multitude of traumatic and non-traumatic etiological factors. Vascular damage, mechanical stress and increased intraosseous pressure have been discussed as contributors to ON. The optimal treatment of ON remains to be determined, since the current gold standard, core decompression, is insufficiently effective. Specific properties of mesenchymal stromal cells (MSCs) provide the rationale for their assessment in advanced stages of ON: Osteoinductive potential has been demonstrated and MSC preparations of suitable quality for use as medicinal products have been developed. Here we review the scant information on the use of allogeneic or autologous MSCs in advanced ON as well as potentially supportive data from pre-clinical studies with autologous bone marrow mononuclear cells (auto BM-MNCs), which have been studied quite extensively and the presumed therapeutic effect of which was attributed to the rare MSCs contained in these cell products. Outcomes in clinical trials with MSCs and auto-BM-MNCs remain preliminary and non-definitive, at best promising, with respect to their pharmacological effect. Clearly, though, the application of any of these cell therapies was technically feasible and safe in that it was associated with low complication rates. The heterogeneity of cell type and source, study protocols, cell manufacturing, cell properties, cell doses and surgical techniques might contribute to inconsistent results.

• Cell-based therapies
• Mesenchymal stromal cells (MSC)
• Osteonecrosis

• Stem cell therapy
• etiologies
• molecular mediator
• osteonecrosis of the femoral head
• signal pathway
• subchondral bone.

• bone
• cells
• osteogenesis
• reconstruction
• regeneration
• stem

Osteonecrosis of the femoral head (ONFH) is a common joint disease and a major cause of morbidity.

In this study Cervi cornus Colla (CCC) deproteinized bone scaffolds were designed and three dimensional (3D)-printed for the repair of ONFH in rats.

The CCC-deproteinized bone scaffolds were 3D-printed using polycaprolactone mixed with the CCC-deproteinized bone powder. The scaffolds were viewed under a scanning electron microscope and subjected to compression analysis. Osteoblasts were isolated from rats and coated onto the scaffolds. Cell proliferation assays were performed with the MTT (3‑[4,5-dimethylthiazole‑2]-2,5-diphenyltetrazolium bromide) kit from Promega. An ONFH was induced in rats and a CCC-deproteinized bone scaffold was implanted into the necrotic femoral head. General observations, X‑ray imaging, and pathological examination of the femoral head were performed to evaluate the treatment of ONFH in the rats.

The scaffolds were porous with a mean pore diameter of 315.70 ± 41.52 nm and a porosity of 72.86 ± 5.45% and exhibited favorable mechanical properties and degradation. In vitro assays showed that osteoblasts accumulated in the pores and adhered to the scaffolds. The CCC-deproteinized bone scaffolds enhanced the proliferation of osteoblasts. The in vivo experiments revealed that the general observation score of rats in the CCC-scaffold implanted group was significantly higher than that in the control group. The X‑ray images showed significant alleviation of ONFH in the CCC-deproteinized bone scaffold implanted rats. The femoral heads of rats in the treatment group showed less destruction or ossification of cartilage cells, few bone cement lines, very little necrosis or irregularities on the cartilage surface and only a small amount of inflammatory cell infiltration in the medullary cavity.

These results suggest that CCC-deproteinized bone scaffold implants facilitated the repair of ONFH in rats. This research provides a new therapeutic approach for the repair of early and mid-term ONFH.

• Animal experiments
• Morbidity
• Osteoblasts
• Polycaprolactone
• Traditional Chinese medicine

• Animals
• Femur
• Osteonecrosis/therapy
• Printing, Three-Dimensional
• Rats
• Tissue Scaffolds

• Stem cells
• cell therapy
• gene therapy
• mesenchymal stem cells
• osteonecrosis of the femoral head
• trauma.

• core decompression
• femoral head
• osteonecrosis
• tongluo shenggu decoction

• Adult
• Bone Transplantation/methods
• Combined Modality Therapy
• Decompression, Surgical/methods
• Drugs, Chinese Herbal/therapeutic use
• Female
• Femur Head Necrosis/drug therapy
• Femur Head Necrosis/surgery
• Humans
• Male
• Middle Aged
• Pain Measurement
• Postoperative Care
• Postoperative Period
• Retrospective Studies
• Severity of Illness Index

• Avascular necrosis of femoral head
• Biological therapies
• Core decompression
• Hip
• Osteonecrosis
• Regenerative therapies

• Arthroplasty, Replacement, Hip/statistics & numerical data
• Biological Therapy/methods
• Decompression, Surgical/methods
• Femur Head Necrosis/mortality
• Femur Head Necrosis/therapy
• Hip Joint/surgery
• Humans
• Survival Analysis
• Survivorship
• Treatment Outcome

• Bone Marrow Transplantation
• Clinical Protocols/standards
• Humans
• Mesenchymal Stem Cell Transplantation
• Musculoskeletal Diseases/therapy
• Orthopedic Procedures/standards

• CAF/11/13 Chief Scientist Office

• Bone graft
• Mesenchymal stem cells
• Osteonecrosis
• Total hip arthroplasty

• Adrenal Cortex Hormones/adverse effects
• Adult
• Aged
• Combined Modality Therapy
• Disability Evaluation
• Female
• Femur Head Necrosis/chemically induced
• Femur Head Necrosis/diagnostic imaging
• Femur Head Necrosis/physiopathology
• Femur Head Necrosis/therapy
• Humans
• Injections, Intra-Articular
• Magnetic Resonance Imaging
• Male
• Mesenchymal Stem Cell Transplantation/adverse effects
• Middle Aged
• Pain Measurement
• Platelet-Rich Plasma
• Preliminary Data
• Prospective Studies
• Recovery of Function
• Time Factors
• Treatment Outcome
• Young Adult

We compared the clinical course of rotator cuff tears between rotator cuff exercise and bone marrow aspirate concentration (BMAC)-platelet rich plasma (PRP) injection to identify the therapeutic effects of BMAC-PRP on partial tear of the rotator cuff tendon.

Twenty-four patients with partial tear of the rotator cuff tendon participated in this study. Twelve patients underwent extraction of BMACs and PRP and received the injection of BMAC-PRP at the tear site under ultrasound guidance. Twelve patients in the control group were asked to perform the rotator cuff exercise for 3 months. Visual analog scale (VAS) and manual muscle test (MMT) scores of the supraspinatus muscle were measured, and the American Shoulder and Elbow Surgeons (ASES) score was recorded before, 3 weeks, and 3 months after injection. Tear size was measured by the greatest longitudinal tear length.

The change in the VAS differed between groups at 3 months (P = 0.039) but not at 3 weeks (P = 0.147). The ASES scores in the BMAC-PRP group changed from 39.4 ± 13.0 to 54.5 ± 11.5 at 3 weeks and 74.1 ± 8.5 at 3 months while those in the control group changed from 45.9 ± 12.4 to 56.3 ± 12.3 at 3 weeks (P = 0.712) and 62.2 ± 12.2 at 3 months (P = 0.011). The tear size decreased at 3 weeks or 3 months after the BMAC-PRP injection but was not significantly different from that in the control group.

BMAC-PRP improved pain and shoulder function in patients with partial tear of the rotator cuff tendon.

The patients were registered in the institutional board registry of Samsung Medical Center (registry number 2014-07-173).

The online version of this article (10.1186/s13018-017-0693-x) contains supplementary material, which is available to authorized users.

• Bone marrow aspirates
• Degeneration
• Platelet-rich plasma
• Rotator cuff tear

• exosome
• extracellular vesicle
• micro-vesicle
• platelet
• platelet-rich plasma.
• regenerative medicine

• Blood Platelets
• Extracellular Vesicles/physiology
• Humans
• Neoplasms/therapy

• bone marrow
• platelet
• rotator cuff
• tendon
• stem cells

• Bone Marrow Transplantation/methods
• Cell Differentiation/physiology
• Cell Movement/physiology
• Cell Proliferation/physiology
• Cells, Cultured
• Chondrogenesis/physiology
• Coculture Techniques
• Collagen Type I/metabolism
• Collagen Type II/metabolism
• Female
• Humans
• Immunohistochemistry
• Middle Aged
• Osteogenesis/physiology
• Platelet-Rich Plasma/cytology
• Platelet-Rich Plasma/physiology
• Prospective Studies
• Rotator Cuff Injuries/therapy
• Single-Blind Method
• Stem Cells/cytology
• Stem Cells/physiology
• Tendons/cytology

• bone marrow aspirate concentrate
• bmac
• mesenchymal stem cells

• hamstring tendinopathy
• hip osteoarthritis
• microfracture
• osteitis pubis
• platelet-rich plasma

Multiple small drilling for core decompression is widely used to preserve the femoral head in patients with avascular necrosis of the femoral head (ANFH). Nevertheless, the clinical outcome remains controversial. Simvastatin has been demonstrated to promote bone formation and reduce bone adsorption. The purpose of this study was to determine whether simvastatin enhanced the effect of multiple decompressions in preventing progression of ANFH and to identify independent risk factors associated with poor results.

We retrospectively analyzed 58 hips in 36 patients, with a follow-up of 36 months. 20 patients (32 hips) underwent multiple drilling combined with simvastatin treatment (SIM group); 16 patients (26 hips) underwent multiple drilling alone (MD group). We defined clinical failure as a requirement for subsequent hip surgery or Harris Hip Score < 75. New occurrence of collapse or increased collapse > 2 mm on plain radiographs was defined as radiological failure.

Successful clinical results were achieved in 27 of 32 hips (84 %) in the SIM group compared with 15 of 26 hips (58 %) in the MD group (OR = 0.2, CI (0.1, 0.6.), P = 0.032). Successful radiological results were achieved in 27 of 32 hips (84 %) in the SIM group and in 16 of 26 hips (61.5 %) in the MD group (P = 0.048). Body mass index, disease stage and location of lesion were independent prognostic factors for overall survival.

We believe that simvastatin could enhance the effects of multiple decompressions in preventing progression of ANFH and reducing the risk of femoral head collapse.

• Core decompression
• Femoral head necrosis
• Multiple decompression
• Preservation of hip
• Simvastatin

• avascular necrosis
• femoral head
• osteonecrosis
• regenerative medicine
• stem cells

• Adult
• Aged
• Aged, 80 and over
• Disease Progression
• Female
• Femur Head Necrosis/chemically induced
• Femur Head Necrosis/physiopathology
• Femur Head Necrosis/therapy
• Glucocorticoids/adverse effects
• Humans
• Male
• Mesenchymal Stem Cell Transplantation
• Mesenchymal Stem Cells/physiology
• Middle Aged
• Young Adult

• osteonecrosis
• on
• avascular necrosis
• avn
• growth factors
• bone morphogenic protein
• bmp

The potential regenerative role of different orthobiologics is becoming more recognized for the treatment of chronic and degenerative musculoskeletal conditions. Over the last few years there has been an increasing number of publications on cell therapy and other orthobiologics for the treatment of avascular necrosis of the femoral head and other hip conditions with promising short–term clinical results. In this article, we have used a systematic search of the literature to identify potentially relevant topics on orthobiologics and then selected those most applicable to hip preservation surgery. We identified several innovative strategies and present a summary of the currently available evidence on their potential role in hip preservation surgery. For many of these treatment strategies there was a lack of clinical evidence and therefore we suggest that there is a need for comparative studies in this field.

• Mesenchymal stromal cells
• Osteonecrosis
• Rehabilitation

Avascular necrosis (AVN) of the femoral head is a progressive disease that predominantly affects younger patients. Although the exact pathophysiology of AVN has yet to be elucidated, the disease is characterized by a vascular insult to the blood supply of the femoral head, which can lead to collapse of the femoral head and subsequent degenerative changes. If AVN is diagnosed in the early stages of the disease, it may be possible to attempt surgical procedures which preserve the hip joint, including decompression of the femoral head augmented with concentrated bone marrow. The use of autologous stem cells has shown promise in halting the progression of AVN of the femoral head, and subsequently preventing young patients from undergoing total hip arthroplasty. The purpose of this study was to review the current use of stem cells for the treatment of AVN of the femoral head.

• avascular necrosis
• concentrated bone marrow
• femoral head
• osteonecrosis
• stem cells