Graduate School of Medicine, Osaka City University scientists have recently analyzed the clinical results of a meniscal repair through the use of bone marrow aspirate or BMA-derived fibrin clots and discovered that the clinical and anatomic failure rates, as well as re-tear, were 10 percent, 6.7 percent, and 3.3 percent, respectively, well lower than their peripheral or PB counterpart.
A Medical Xpress report specified, while this is not the fountain of use, through this new approach, scientists may have improved healing in joints, even in parts that become weaker with age.
The meniscus is tough, yet flexible tissue found in joints such as the knees and wrist, helping them absorb shock during movement.
Intermittently, tears can take place in the meniscus because of an awkward movement or structural weakness due to old age.
Fibrin
When people are young, there is an abundance of blood flowing to this site allowing for rapid healing, although with the age, the meniscus is receiving less blood, with the innermost area becoming avascular.
Tears in this area, this report specified, do not heal the normal way, frequently necessitating surgery. Essentially, surgeons can draw fibrin, described by the National Library of Medicine, as a protein involved in blood clotting from the PB or BMA, and implant a fibrin blood clot into the injured site to help with healing. Nevertheless, little is known about the differential efficacy of fibrin from both the PB and BMA areas.
Results of the study, "Biochemical Characteristics and Clinical Result of Bone Marrow-Derived Fibrin Clot for Repair of Isolated Meniscal Injury in the Avascular Zone", were published in Arthroscopy: The Journal of Arthroscopic & Related Surgery.
Bone Marrow Aspirate and Peripheral Blood
According to lecturer Yusuke Hashimoto, there are different methods of meniscal repair that attempt to prevent re-tear, although the re-tear rate still goes beyond 20 percent.
To find out if BMA can decrease this number, the researchers needed to first understand the growth factor levels involved in tissue repair found in BMA and then, discover the impacts BMA-derived fibrin clots had when sutured into tissue during meniscal surgery.
The research team prepared fibrin clots for cytokine measurement by collecting bone marrow fluid and peripheral blood from five patients who were undergoing meniscal surgery.
Professor Hiroaki Nakamura explained, Cytokines are proteins that kindle the reparative process, and through them, they were able to gauge the growth factor levels such as bFGF, TGFβ, and SDF-1.
As a result, cell count evaluations showed that BMA was more abundant in such growth factors compared to PB.
Improvements in Meniscus Condition
Following the evaluations, as a two-year follow-up post-surgery, they investigated pre-and postoperative clinical outcomes and the meniscus' healing rate in 30 cases of meniscal repair that was combined with a BMA fibrin clot.
MRI results showed substantial improvements in the meniscus tear, as explained in the University of Michigan Health site, compared to the preoperative results.
In relation to this, X-ray evaluation showed no substantial progression of knee deformity. PB clots, Hashimoto explained, have been widely reported as a material to improve meniscal healing.
Nonetheless, with a reported 20 percent of meniscal repairs having reoperation at long-term follow-up, continued the professor, their method of introducing BMA-derived fibrin clots into the injured area may become a treatment for meniscus injuries that until to date, have not been treatable.
Related information is shown on Arthroscopy Technique's YouTube video below:
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