Treatment of a full-thickness articular cartilage defect in the femoral condyle of an athlete with autologous bone-marrow stromal cells R. Kuroda, M.D.,

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Treatment of a full-thickness articular cartilage defect in the femoral condyle of an athlete with autologous bone-marrow stromal cells R. Kuroda, M.D., K. Ishida, M.D., T. Matsumoto, M.D., T. Akisue, M.D., H. Fujioka, M.D., K. Mizuno, M.D., H. Ohgushi, M.D., S. Wakitani, M.D., M. Kurosaka, M.D. Osteoarthritis and Cartilage Volume 15, Issue 2, Pages 226-231 (February 2007) DOI: 10.1016/j.joca.2006.08.008 Copyright © 2006 Osteoarthritis Research Society International Terms and Conditions

Fig. 1 (A) Anterior–posterior X-radiographic view of the weight-bearing knee before surgery. The image reveals a radiolucent area (*) within the medial femoral condyle. (B) Anterior–posterior X-radiographic view of the weight-bearing knee 1 year after surgery. No radiolucent area is now apparent within the medial femoral condyle. Osteoarthritis and Cartilage 2007 15, 226-231DOI: (10.1016/j.joca.2006.08.008) Copyright © 2006 Osteoarthritis Research Society International Terms and Conditions

Fig. 2 (A, B) Magnetic resonance images before surgery. A defect is apparent within the medial femoral condyle, the subchondral bone is oedematous, and the posterior portion of the medial meniscus has degenerated. (C, D) Magnetic resonance images 1 year after surgery. The bone is no longer oedematous, but chondral and subchondral irregularities are apparent in the repaired area. Osteoarthritis and Cartilage 2007 15, 226-231DOI: (10.1016/j.joca.2006.08.008) Copyright © 2006 Osteoarthritis Research Society International Terms and Conditions

Fig. 3 (A) Arthroscopic findings before surgery. A 20×30-mm full-thickness cartilage defect (ICRS grade IV) is apparent within the weight-bearing area of the medial femoral condyle. (B) Arthroscopic findings 7 months after surgery. The defect is completely covered with tissue, which is a little softer than the surrounding articular cartilage. Osteoarthritis and Cartilage 2007 15, 226-231DOI: (10.1016/j.joca.2006.08.008) Copyright © 2006 Osteoarthritis Research Society International Terms and Conditions

Fig. 4 High-resolution imaging of the defect area 1 year after surgery. (A) Appearance of the tissue after staining with Safranin-O. Three distinct layers are apparent. The first (upper) layer consists of fibrous tissue, and is presumably the periosteal patch. The second (middle) layer is composed of a hyaline-like type of cartilage tissue, which stains positively with Safranin-O. The third (lower) layer is subchondral bone. (B) After treatment with Toluidine Blue, the middle layer stains metachromatically. (C) Higher-magnification view of the Toluidine-Blue-stained middle layer of tissue revealing the chondrocyte-like appearance of the cells and an abundant extracellular matrix. (D) Immunohistochemical staining of the tissue for type-II collagen reveals a positive reaction within the middle layer. Osteoarthritis and Cartilage 2007 15, 226-231DOI: (10.1016/j.joca.2006.08.008) Copyright © 2006 Osteoarthritis Research Society International Terms and Conditions