A. Gobbi (Milano, IT)

Orthopaedic Arthroscopic Surgery International Sport and Medicine
Alberto Gobbi graduated in 1983 and completed his residency program in 1988 in Orthopaedic surgery at Milan University and Sports Medicine in Genova in 1992. Dr. Gobbi himself was an athlete at national level and served the Italian National Olympic Committee; for the World Motocross Championship; African Rallies; offshore boat racing; down-hill ski; volley and basketball. He was nominated “azzurro d’Italia” in 1998. His participation in high-risk sports led him to focus on trauma; surgical technique and advanced rehabilitation; he became a point of reference for many International athletes. He worked for several years with many major International experts in orthopaedic surgery; arthroscopy and regenerative medicine who are now considered the Giants. He was one of the first Europeans to join the International Cartilage Repair Society. In 1996 he became an International member of the American Academy of Orthopaedic Surgeons (AAOS) and then Honorary Member of the Arthroscopy Association of North America (AANA). Since then he has collaborated with the most important scientific Societies including ISAKOS and ESSKA. Dr Gobbi pioneers research on biological therapies of orthopaedic injuries; establishing an international reputation in the field of regenerative medicine and developing advanced surgical techniques with the use of mesenchymal stem cells and growth factors. He performs highly qualified scientific; surgical and educational activities at International level. He served as a reviewer for many journals; is Associate Editor of "Cartilage" since 2010 and in 2012 he received the award for Best International Publication in an American Journal. In 2011 he was acknowledged as a Visiting Professor at Kobe & Osaka University; Japan; in 2014 he was nominated Visiting Professor in the Department of Orthopaedic Surgery directed by Prof. David Amiel at the University of California San Diego - UCSD. In 2018 received certificate of appreciation from Yonsei University Korea and he was nominated Honorary professor at the University of Peking and at the N.U.S. National University of Singapore where he also delivered the VK Pillay Lecturer. He founded OASI Bioresearch Foundation Gobbi Onlus (NPO) which is recognized as an International Teaching Center by ISAKOS and ICRS and has dedicated his time to teaching hundreds of fellows during the last 20 years. He has published over 200 scientific papers in international peer-reviewed journals; edited several books and contributed many chapters in scientific publications. He currently serves on the board of directors of ISAKOS and he is the ICRS Past President (2018-2019).

Presenter Of 1 Presentation

Extended Abstract (for invited Faculty only) Stem Cells

3.2.3 - MSCs: Where is the Evidence?

Presentation Topic
Stem Cells
Date
12.04.2022
Lecture Time
15:00 - 15:15
Room
Potsdam 3
Session Type
Special Session

Abstract

Introduction

Injury of the knee articular cartilage and osteochondral unit is a significant cause of functional limitation in which the goal of treatment is preservation of the native knee joint. There are a variety of cell-based cartilage and osteochondral unit repair methods that may be used to treat different injuries, given the limited potential for cartilage injury to heal without intervention. Restoration of hyaline-like cartilage is the ultimate goal in treatment of osteochondral unit as it offers an improved durability of repaired tissue and preferable wear characteristics. Over the years many cell-based therapies have been developed to address the need for the long-term viability of repaired tissue. Some of the techniques use mesenchymal stem cells (MSCs) as a core ingredient for tissue repair.

Content

Microfracture, a bone marrow stimulation technique using MSCs, when used wisely and with caution in selected patients has shown good clinical results at short-term follow up. Nonetheless, deterioration of the clinical outcome may be expected after 2 -3 years post-treatment, and degenerative changes are present at long-term follow-up, with a higher rate in older patients with extensive and multiple lesions [1, 2]. Autologous Matrix-Induced Chondrogenesis (AMIC) has emerged as a modification of the microfracture technique by addition of a collagen scaffold. However both of these techniques raise a concern of the damage of the subchondral bone and the formation of microcysts, that may quicken the deterioration of the cartilage and compromise the articular surface for future procedures [3, 4]. Autologous chondrocyte implantation (ACI) consists of a two-step procedure; first, a sample of healthy cartilage is harvested from a non-weight bearing site, followed by an in vitro cell expansion. The second step is the implantation of the chondrocyte suspension into the cartilage defect. Compared to bone marrow stimulating techniques such as microfracture, ACI technique has appeared to be superior over time due to longer-lasting effects, without the concerns of destruction of the subchondral bone [5,6]. However, while techniques using autologous chondrocytes have demonstrated durable cartilage repair, these methods require the patient to undergo two surgical procedures due to the need for chondrocyte culture.

Hyaluronic acid-based scaffold with bone marrow aspirate concentrate (HA-BMAC) was developed 30 years ago, it allowed the treatment of larger cartilage defects in a one-step surgery with biologic tissue such as mesenchymal stem cells, chondrocytes, or platelet-rich plasma. This technique has provided long-term results and has proven its superiority to microfracture due to lasting effect over ten years compared to the 2-3 years with microfracture technique [2]. Moreover, it can be used even in cases of multiple compartment injury, extensive lesions, or in older patients [7-10]. This procedure provides a good source of chondrocytes, whether directly or through differentiation of multipotent precursor cells, capable of producing hyaline-like cartilage, with minimal formation of fibrocartilage tissue [10].

Lately more attention was brought to the osteochondral unit and especially the role of subchondral bone in maintaining homeostasis of the joint [4]. Bone marrow lesions (BMLs) are the focal changes in the subchondral bone and can be identified by magnetic resonance imaging (MRI). A technique using MSCs to treat BMLs, the Osteo-Core-Plasty (Marrow Cellution™) is a minimally invasive subchondral bone augmentation that offers both biologic and structural components to optimize the osteochondral environment for regeneration. This technique may also by applied in treatment of insufficiency fractures, subchondral cysts, and avascular necrosis [11, 12].

MSCs are also found in other sources than bone marrow, one of which is fat tissue. Adipose derived Mesenchymal Stem Cells (ADMSCs) are quickly becoming a viable source of MSC, not only because they are easy to harvest but also have a high concentration of progenitor cells. Primary outcomes of the use of microfragmented adipose tissue (MFAT) injection in elderly patients with knee osteoarthritis (OA) have shown good clinical results compared with the pre-treatment state and could be an alternative treatment for elderly patients 60 years or older [13, 14].

Summarizing, over 30 years of using MSCs have shown good and very good clinical outcomes in treatment of osteochondral unit lesions and OA.

References

References:

1. Gobbi A, Karnatzikos G, Kumar A. Long-term results after microfracture treatment for full-thickness knee chondral lesions in athletes. Knee Surg Sports Traumatol Arthrosc. 2014 Sep;22(9):1986–96.

2. Gobbi A, Whyte GP. One-Stage Cartilage Repair Using a Hyaluronic Acid-Based Scaffold With Activated Bone Marrow-Derived Mesenchymal Stem Cells Compared With Microfracture: Five-Year Follow-up. Am J Sports Med. 2016 Nov;44(11):2846–54.

3. Frank RM, Cotter EJ, Nassar I, Cole B. Failure of Bone Marrow Stimulation Techniques. Sports Med Arthrosc Rev. 2017 Mar;25(1):2–9.

4. Gobbi A, Alvarez R, Irlandini E, Dallo I. Current Concepts in Subchondral Bone Pathology. In: Gobbi A, Lane JG, Longo UG, Dallo I, editors. Joint Function Preservation: A Focus on the Osteochondral Unit [Internet]. Cham: Springer International Publishing; 2022

5. Gobbi A, Lane JG, Dallo I. Editorial Commentary: Cartilage Restoration-What Is Currently Available? Arthroscopy. 2020 Jun;36(6):1625–8.

6. Brittberg M, Lindahl A, Nilsson A, Ohlsson C, Isaksson O, Peterson L. Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. N Engl J Med. 1994 Oct 6;331(14):889–95.

7. Gobbi A, Karnatzikos G, Sankineani SR. One-step surgery with multipotent stem cells for the treatment of large full-thickness chondral defects of the knee. Am J Sports Med. 2014 Mar;42(3):648–57.

8. Gobbi A, Karnatzikos G, Scotti C, Mahajan V, Mazzucco L, Grigolo B. One-Step Cartilage Repair with Bone Marrow Aspirate Concentrated Cells and Collagen Matrix in Full-Thickness Knee Cartilage Lesions: Results at 2-Year Follow-up. Cartilage. 2011 Jul;2(3):286–99.

9. Gobbi A, Scotti C, Karnatzikos G, Mudhigere A, Castro M, Peretti GM. One-step surgery with multipotent stem cells and Hyaluronan-based scaffold for the treatment of full-thickness chondral defects of the knee in patients older than 45 years. Knee Surg Sports Traumatol Arthrosc. 2017 Aug;25(8):2494–501.

10. Gobbi A, Whyte GP. Long-term Clinical Outcomes of One-Stage Cartilage Repair in the Knee With Hyaluronic Acid-Based Scaffold Embedded With Mesenchymal Stem Cells Sourced From Bone Marrow Aspirate Concentrate. Am J Sports Med. 2019 Jun;47(7):1621–8.

11. Szwedowski D, Dallo I, Irlandini E, Gobbi A. Osteo-core Plasty: A Minimally Invasive Approach for Subchondral Bone Marrow Lesions of the Knee. Arthrosc Tech. 2020 Nov;9(11):e1773–7

12. Gobbi A, Dallo I. Osteo-Core-Plasty technique for the treatment of a proximal tibial subchondral cystic lesion. 2021;

13. Dallo I, Morales M, Gobbi A. Platelets and Adipose Stroma Combined for the Treatment of the Arthritic Knee. Arthroscopy Techniques. 2021 Oct 6;10.

14. Gobbi A, Dallo I, Rogers C, Striano RD, Mautner K, Bowers R, et al. Two-year clinical outcomes of autologous microfragmented adipose tissue in elderly patients with knee osteoarthritis: a multi-centric, international study. Int Orthop. 2021 May;45(5):1179–88.

Collapse

Moderator Of 2 Sessions

Potsdam 1 Plenary Session
Session Type
Plenary Session
Date
15.04.2022
Time
08:30 - 09:30
Room
Potsdam 1
Session Description
Worldwide experts discuss the advances, obstacles, and regulatory issues in clinical therapy, osteoarthritis treatments, and translational gene therapy.
Session Learning Objective
  1. Participants will learn about the feasibility and challenges of developing a novel clinical trial based on preclinical results.
CME Evaluation
Potsdam 1 Plenary Session
Session Type
Plenary Session
Date
15.04.2022
Time
09:30 - 10:30
Room
Potsdam 1
Session Description
Worldwide experts present in a confronted discussion opposing opinions with regard to relevant actual treatment modalities or scientific paradigms. High profile argumentation and evidence-based discussion on "hot" topics of cartilage repair.
Session Learning Objective
  1. Participants will learn how an academic confronted discussion should be performed, based on randomized trials and high-quality GLP GMP studies. Of course the style of argumentation and discussion in high profile experts is a great and interesting experience anyway.
CME Evaluation

Meeting Participant Of

Glienicke Board Room (18) ICRS Committee Meeting

Executive Board Meeting

Session Type
ICRS Committee Meeting
Date
12.04.2022
Time
08:00 - 09:45
Room
Glienicke Board Room (18)
Session Description
Only for invited Committee Members
Bellevue Plenary Session
Session Type
Plenary Session
Date
14.04.2022
Time
17:30 - 18:30
Room
Bellevue
Session Description
All ICRS members, present in Berlin are expected to attend the ICRS General Member’s Assembly. Retired Members and Corporate Members have no right to vote but are most welcome to attend. It is of utmost importance that as many members as possible attend this important meeting and take part in decision-making and approval processes of our association.