A novel, minimally-invasive technique of cartilage repair in the human knee using arthroscopic microfracture and injections of mesenchymal stem cells and hyaluronic acid--a prospective comparative study on safety and short-term efficacy

Ann Acad Med Singap. 2012 Nov;41(11):511-7.


Introduction: Most current cell-based cartilage repair techniques require some form of scaffolds and 2 separate surgical procedures. We propose a novel, scaffold-less technique of cartilage repair in the human knee that combines arthroscopic microfracture and outpatient intra-articular injections of autologous bone marrow-derived mesenchymal stem cells (MSCs) and hyaluronic acid (HA).

Materials and methods: Seventy matched (age, sex, lesion size) knees with symptomatic cartilage defects underwent cartilage repair with the proposed technique (n = 35) or an open technique (n = 35) in which the MSCs were implanted beneath a sutured periosteal patch over the defect. Prospective evaluation of both groups were performed using the International Cartilage Repair Society (ICRS) Cartilage Injury Evaluation Package, which included questions from the Short-Form (SF-36) Health Survey, International Knee Documentation Committee (IKDC) subjective knee evaluation form, Lysholm knee scale, and Tegner activity level scale. Postoperative magnetic resonance imaging (MRI) evaluation was also performed at 1 year for most patients.

Results: There were no clinically significant adverse events reported through the course of our study. At the fi nal follow-up (mean = 24.5 months), there was significant improvement in mean IKDC, Lysholm, SF-36 physical component score and visual analogue pain scores in both treatment groups.

Conclusion: In the short term, the results of this novel technique are comparable to the open procedure with the added advantages of being minimally invasive and requiring only a single operation under general anaesthesia. Its safety has been validated and its efficacy is currently being evaluated in an ongoing randomised controlled trial.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Arthroscopy / methods*
  • Cartilage, Articular / injuries*
  • Combined Modality Therapy / methods
  • Female
  • Humans
  • Hyaluronic Acid / therapeutic use*
  • Knee Injuries / therapy*
  • Magnetic Resonance Imaging
  • Male
  • Mesenchymal Stem Cell Transplantation / methods*
  • Outcome Assessment, Health Care
  • Patient Safety
  • Prospective Studies
  • Singapore
  • Viscosupplements / therapeutic use*


  • Viscosupplements
  • Hyaluronic Acid