Transplantation of Bone Marrow Stem Cells Stimulated by Proteins Scaffold to Heal Defects Articular Cartilage of the Knee

Inclusion Criteria:

• Active patients (30 to 75 years)
• A localized osteochondral defect of both condyle and/or tibia grade 4 (ICRS classification)
• with cartilage on the tibial surface no more than grade 3-4, of size < 3-4 cm2, with 3/4 of meniscus present.
• Stable knee ; previous ligament reconstruction, if stable
• A defect that is 1 - 4 cm2 or more, up to 6 cm2, located on the femoral condyle and /or less of 4 cm2 for tibial plate, and IKS score <75.
• Kissing lesions admitted
• Ability to understand and willingness to sign consent form

Exclusion Criteria:

• Patients younger than 30 years and older than 75 years
• Diffuse and advanced articular cartilage degeneration of the joint
• Axial malalignment, meniscal pathology, and ligamentous instability are relative contraindications that have to be dealt with primarily either concomitantly or before the transplantation during 1 of the 2 stages of the procedure. Refusal of the patient to address these conditions in presence of a cartilage lesion is a criterion for exclusion from the study, to avoid the impact of these knee pathologies on the final results
• Existing infection in or around the joint & lesions of infectious or oncologic etiology.
• Debilitated patients.
• Immunocompromised patients.
• Patients with autoimmune disorders & systemic inflammatory disease.
• Preoperative poor neurological or vascular status of the affected limb.
• Specific contraindications include the use of tobacco and medications that may impair cell proliferation, such as NSAIDs and immunosuppressive drugs. Patients must be nicotine-free (stop smoking) prior to the procedure, as studies have shown that the oxidative effect of smoking impairs cell function and subsequent healing.