BST-CarGel®: An Enhanced Bone Marrow Stimulation Treatment

Bone marrow stimulation techniques such as abrasion arthroplasty [1], Pridie drilling [2], and microfracture [3] attempt to use the natural wound repair response elicited by a blood clot originating from the bone marrow. Channels surgically made in the subchondral bone below the cartilage lesion permit access to marrow blood and blood components including stem cells intended to provide an environment for wound healing that ultimately leads to cartilage regeneration. Microfracture, which has been frequently used as a first-line treatment for small cartilage lesions, has the advantage of being simple and safe, cost-effective, and minimally invasive with a low morbidity rate [4, 5]. On the other hand, the procedure results in a mixed repair tissue with mainly fibrous or fibrocartilaginous properties [6–10], limited collagen type II and glycosaminoglycan (GAG) levels, and poor mechanical properties compared to native hyaline cartilage. Indeed, the long-term durability of this repair tissue has been questioned with many reports showing a failure of repair tissue and a return of associated clinical symptoms starting as early as 24 months posttreatment [8, 11, 12].