Utilization of Leech Therapy after Rhinoplasty.

BACKGROUND: The use of medicinal leeches in modern reconstructive surgery is well-described. Leech therapy after rhinoplasty has not been previously well-characterized. METHODS: The medical records of all patients who underwent open rhinoplasty by a single surgeon over a 4-year period were reviewed. Patient demographics, including age, sex, medical comorbidities, number of previous rhinoplasty surgeries, time to utilization of leech therapy, adjunct therapies used, resolution of skin changes, and smoking status, were recorded. Operative reports were reviewed for pertinent information, including number of tip grafts used, graft materials used, and placement of septal extension grafts or "unicorn" grafts. RESULTS: Between April of 2016 and March of 2020, 545 patients underwent rhinoplasty performed by the senior author (P.S.N.). Of these patients, 39 (7.2 percent) underwent leech therapy postoperatively. The mean age of included patients was 47.4 years. Of the patients who required leech therapy, 34 (87.2 percent) had undergone revision rhinoplasty. The mean number of previous rhinoplasties was 3.4. The mean number of tip grafts used was 2.6. Thirty-three patients (84.6 percent) had either a traditional septal extension graft or unicorn graft placed. Nine patients (23.1 percent) were former smokers. Complete resolution of skin color changes was seen in 38 patients (97.4 percent). There were no major complications after leech therapy. CONCLUSIONS: Leech therapy is a useful tool for the rhinoplasty surgeon, particularly in the setting of complex revision rhinoplasty, in patients who have undergone multiple previous nasal surgical procedures, or in patients who require significant cartilage grafting to reconstruct the nasal tip or lengthen the nose. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Effectiveness and safety of polydioxanone thread-embedding acupuncture (TEA) and electroacupuncture (EA) treatment for knee osteoarthritis (KOA) patients with postoperative pain: An assessor-blinded, randomized, controlled pilot trial.

BACKGROUND: Degenerative knee osteoarthritis (KOA) shows an increase in morbidity with improvement in the living conditions and extended lifespans. Treatment for degenerative KOA has been gaining attention since it significantly affects the life of the elderly population and is also associated with increased expenses for medical services and high socioeconomic costs. Treatments for degenerative KOA include nondrug therapy, drug therapy, and surgical treatment. For cases that show little response to conservative treatment but have not involved severe deformation of the knee, procedures such as arthroscopic surgery, autologous chondrocyte implantation, or autologous osteochondral transplantation can be performed. However, effective treatment is required for patients experiencing sustained knee pain after surgery. Although studies confirming the therapeutic effects of acupuncture or thread-embedding acupuncture (TEA) treatment for degenerative KOA have been reported, clinical studies on a combination of TEA and electroacupuncture (EA) in patients complaining of knee pain after arthroscopic surgery, autologous chondrocyte implantation, or autologous osteochondral transplantation have not yet been reported. Therefore, this study aimed to evaluate the effectiveness and safety of this combination treatment in patients with persistent knee pain after arthroscopic surgery, autologous chondrocyte implantation, or autologous osteochondral transplantation. METHODS/DESIGN: This study has been designed as a 2-group, parallel, single-center, randomized, controlled, assessor-blinded trial. Thirty-six patients with degenerative KOA who complained of pain even after arthroscopic surgery, autologous chondrocyte implantation, or autologous osteochondral transplantation will be randomized to either the (TEA + EA + Usual care) group or the (Usual care only) group in a 1:1 ratio. The patients in the (TEA + EA + Usual care) group will receive TEA treatment once a week for 4 weeks for a total of 4 sessions and EA twice a week for a total of 8 sessions while continuing usual care. The (Usual care only) group will only receive usual care for 4 weeks. To assess the efficacy of the TEA and EA combination treatment, the visual analogue scale, the Korean version of the Western Ontario and McMaster Universities Osteoarthritis Index, the EuroQol 5-Dimension 5-Level, and the doses of the rescue drug taken will be evaluated at baseline (1W) and weeks 2 (2W), 4 (4W), 6 (6W), and 8 (8W). The primary efficacy endpoint is the mean change in visual analogue scale at week 4 (4W) compared to baseline. Adverse events will be assessed at every visit. DISCUSSION: This study will provide useful data for evaluating the clinical efficacy and safety of TEA and electroacupuncture combination treatment for improving pain and quality of life after surgery for degenerative KOA. TRIAL REGISTRATION: Clinical Research Information Service of Republic of Korea (CRIS- KCT0004804), March 6, 2020.

Use of Particulated Juvenile Articular Cartilage Allograft for Osteochondral Lesions of the Wrist.

BACKGROUND: Articular cartilage injuries are a common injury among young, active patients, and the most appropriate treatment for these injuries remains controversial. A promising new technology in the treatment of high-grade cartilage injuries is particulated juvenile articular cartilage (PJAC) allograft (DeNovo NT, Zimmer, Warsaw, Indiana). This has been shown to be successful in multiple joints including the knee, talus, and elbow. No studies or case reports exist in supporting or discouraging its use in injuries of the wrist, in specific, the scaphoid. METHODS: The use of PJAC allograft is described for the treatment of an active 21-year-old male with an Outerbridge Grade IV chondral lesion on the proximal pole of his right scaphoid and right distal radius scaphoid facet who had failed conservative management. The patient was followed clinically and radiographically for 21 months. RESULTS: The patient had return to full sport (jujutsu) and full range-of-motion, both of which represented an improvement from his preoperative exam. Radiographically, the chondral lucency seen had decreased in size and was almost completely absent on radiographs after 21 months. CONCLUSIONS: The results of this case suggest that PJAC can be used safely and effectively in the wrist thereby potentially broadening the indications for its use.

Effect of Round Window Reinforcement on Hearing: A Temporal Bone Study With Clinical Implications for Surgical Reinforcement of the Round Window.

HYPOTHESIS: Round window reinforcement leads to conductive hearing loss. BACKGROUND: The round window is stiffened surgically as therapy for various conditions, including perilymphatic fistula and superior semicircular canal dehiscence. Round window reinforcement reduces symptoms in these patients. However, it also reduces fluid displacement in the cochlea and might therefore increase conductive hearing loss. METHODS: Perichondrium was applied to the round window membrane in nine fresh-frozen, nonpathologic temporal bones. In four temporal bones cartilage was applied subsequently. Acoustic stimuli in the form of frequency sweeps from 250 to 8000 Hz were generated at 110 dB sound pressure level. A total of 16 frequencies in a 1/3-octave series were used. Stapes velocities in response to the acoustic stimuli were measured at equally spaced multiple points covering the stapes footplate using a scanning laser Doppler interferometry system. Measurements were made at baseline, after applying perichondrium, and after applying cartilage. RESULTS: At frequencies up to 1000 Hz perichondrium reinforcement decreased stapes velocities by 1.5 to 2.9 dB compared with no reinforcement (p value = 0.003). Reinforcement with cartilage led to a further deterioration of stapes velocities by 2.6 to 4.2 dB at frequencies up to 1000 Hz (p value = 0.050). The higher frequencies were not affected by perichondrium reinforcement (p value = 0.774) or cartilage reinforcement (p value = 0.644). CONCLUSION: Our results seem to suggest a modest, clinically negligible effect of reinforcement with perichondrium. Placing cartilage on the round window resulted in a graded effect on stapes velocities in keeping with the increased stiffness of cartilage compared with perichondrium. Even so, the effect was relatively small.

Comparison of natural crosslinking agents for the stabilization of xenogenic articular cartilage.

Osteochondral xenografts are potentially inexpensive, widely available alternatives to fresh allografts. However, antigen removal from xenogenic cartilage may damage the extracellular matrix and reduce compressive stiffness. Non-crosslinked xenogenic cartilage may also undergo rapid enzymatic degradation in vivo. We hypothesized that natural crosslinking agents could be used in place of glutaraldehyde to improve the mechanical properties and enzymatic resistance of decellularized cartilage. This study compared the effects of genipin (GNP), proanthocyanidin (PA), and epigallocatechin gallate (EGCG), on the physical and mechanical properties of decellularized porcine cartilage. Glutaraldehyde (GA) served as a positive control. Porcine articular cartilage discs were decellularized in 2% sodium dodecyl sulfate and DNase I followed by fixation in 0.25% GNP, 0.25% PA, 0.25% EGCG, or 2.5% GA. Decellularization decreased DNA by 15% and GAG by 35%. For natural crosslinkers, the average degree of crosslinking ranged from approximately 50% (EGCG) to 78% (GNP), as compared to 83% for the GA control. Among the natural crosslinkers, only GNP significantly affected the disc diameter, and shrinkage was under 2%. GA fixation had no significant effect on disc diameter. Decellularization decreased aggregate modulus; GA and GNP, but not EGCG and PA, were able to restore it to its original level. GNP, PA, and GA conferred a similar, almost complete resistance to collagenase degradation. EGCG also conferred substantial resistance but to a lesser degree. Overall, the data support our hypothesis and suggest that natural crosslinkers may be suitable alternatives to glutaraldehyde for stabilization of decellularized cartilage. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1037-1046, 2016.

Blood flow dynamics in reconstructed auricles.

Ear reconstruction with autologous rib cartilage is performed in stages. Restitution of blood flow between the separate stages is crucial to obtain a good result. Laser Doppler perfusion imaging (LDPI) and local temperature were measured in reconstructed and normal ears in response to indirect heating. Ten persons who had had a unilateral ear reconstruction were included in the study. At a minimum, 157 days had passed since the last operation. LDPI showed no difference in blood flow between the reconstructed ear and the normal ear, neither before nor after indirect heating. The upper part of the normal ear was slightly cooler than the corresponding part in the reconstructed ear. Indirect heating caused an increase of LDPI-values and temperatures in the upper, middle, and lower part of the ear both in the reconstructed ear and the normal one. Skin blood flow recovers after 3-stage ear reconstruction and shows normal dynamic response upon indirect heating.

Improving outcomes for composite grafts in nasal reconstruction.

PURPOSE OF REVIEW: Auricular composite grafting is a useful technique for the reconstruction of select nasal defects. However, unpredictable graft survival has been the primary limitation of this technique. The literature was reviewed to evaluate the effectiveness of various surgical, pharmacologic, hyperbaric, and hypothermic interventions to improve composite graft survival. RECENT FINDINGS: Although no statistically significant surgical interventions were found, several techniques appear promising. There are a number of studies demonstrating the beneficial effects of perioperative and postoperative corticosteroid administration. Other agents studied have had modest to no benefit. Hyperbaric oxygen therapy holds promise but the expense, practicality, and lack of an established optimal treatment protocol remain obstacles to routine use. SUMMARY: The use of corticosteroids and postoperative cooling are relatively inexpensive and effective modalities to improve auricular composite graft survival when used for nasal reconstruction. Hyperbaric oxygen therapy may have a role, but more research is needed before it is employed routinely.

Effects of early commercial air travel on graft healing rates after tympanoplasty.

OBJECTIVES: We sought to determine whether commercial air travel soon after tympanoplasty significantly affects graft healing rates. METHODS: We performed a retrospective analysis of 169 patients who underwent tympanoplasty from 1993 to 2009, comparing two groups of patients: 69 patients who flew 1 day after surgery and 100 who did not. The confounding factors analyzed were side of surgery, size of perforation, surgical approach, graft material, and grafting technique. The primary outcome measure analyzed was successful closure of the perforation at the first follow-up visit, at 4 weeks, evidenced by direct otoendoscopic examination. RESULTS: There was no significant difference in the confounding variables between the two groups. There was no significant difference in the primary outcome measure of graft healing rates between the two groups (p = 0.494). Additionally, the overall graft healing rates compared favorably with previously published data from other authors. CONCLUSIONS: Early commercial air travel after tympanoplasty does not significantly affect graft healing rates and should be considered a relatively safe option.

Management of the nasal dorsum in rhinoplasty: a systematic review of the literature regarding technique, outcomes, and complications.

BACKGROUND: Few operations in plastic surgery have generated as much discussion and debate as that of rhinoplasty. The aim of this review is to explore the existing body of literature with regard to techniques addressing the nasal dorsum. The authors' attempt was to isolate those articles providing either retrospective or prospective data pertaining to outcomes and complications of the implemented technique(s). METHODS: A comprehensive review of the literature was conducted consisting of articles published between January 1, 1950, and September 1, 2010. The search included MEDLINE by means of OVID and PubMed in addition to the Cochrane database. Through aggressive investigation, the review was supplemented with articles not initially identified that met inclusion criteria. RESULTS: Of the 5437 articles returned from the initial search, 115 were initially selected on the basis of abstract review. Of these, 59 met the predetermined criteria for inclusion. An additional 24 articles meeting criteria were identified. Of note, some articles provided both augmentation and reduction data. Eighty-nine percent of studies focused on augmentation, showing acceptable results with generally low levels of complications with use of various types of cartilage, bone, and soft tissue. Use of synthetic implants such as Gore-Tex and silicone showed higher complication rates, including displacement and extrusion, but overall acceptable results. Dorsal reduction was reviewed in 13 percent of studies, with a multitude of approaches, presenting mostly satisfactory results. CONCLUSIONS: A vast majority of the published data related to management of the nasal dorsum is low-level evidence. Future studies should aim to provide level II or III evidence. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Predictors of surgical and hearing long-term results for inlay cartilage tympanoplasty.

OBJECTIVE: To determine the prognostic factors that affect surgical and audiologic outcomes in inlay tympanoplasty after long-term follow-up. DESIGN: Case series study. SETTING: Tertiary referral center. PATIENTS: Sixty-two patients who underwent 71 procedures were enrolled in the study. Patient ages ranged from 31 to 87 years (mean [SD] age, 61.2 [12.9] years). Mean (SD) follow-up was 635.7 (284.7) days. The inclusion criteria were (1) inlay cartilage tympanoplasty performed using local anesthesia via a transcanal route, (2) chronic otitis media with stable perforation, and (3) dry ear without middle ear disease. MAIN OUTCOME MEASURES: The success rate and hearing change at the last follow-up visit. RESULTS: The overall success rate was 87.3% at the last visit. Using multivariate analysis, sex, age, size of perforation, side of perforation, and the presence of diabetes mellitus and external auditory canal otomycosis did not affect the success. Smoking was the only independent factor for the prognosis of surgical outcome (odds ratio [OR], 8.16; 95% confidence interval [CI], 1.74-36.89; P < .006). On the other hand, age (OR, 6.62; 95% CI, 1.13-38.47; P = .03) and perforation size (OR, 0.11; 95% CI, 0.10-0.79; P = .03) were independent factors for the prognosis of audiologic outcomes. CONCLUSIONS: The frequency of failure was significantly higher for smokers than for nonsmokers. To quit smoking is highly recommended preoperatively for individuals scheduled for chronic otitis media inlay tympanoplasty intervention. Younger patients and those with larger perforations (>50%) were more likely to benefit from this operation.

Long-term results of radiation prophylaxis for heterotopic ossification in the temporomandibular joint.

PURPOSE: To assess the long-term efficacy and toxicity of radiation therapy (RT) for postoperative prophylaxis of recurrent heterotopic ossification (HO) in the temporomandibular joint (TMJ). PATIENTS AND METHODS: Twelve patients (18 joints) with bony ankylosis of the TMJ from HO were referred to undergo RT after arthrotomy with osseous recontouring, gap arthroplasty, or costochondral grafting. Treatment consisted of 10 Gy in 5 daily fractions to a field encompassing the TMJ with an adequate margin. RT was initiated 1 to 3 days postoperatively. Response to therapy was assessed by routine x-ray films obtained preoperatively, immediately postoperatively, and at follow-up by use of the Turlington-Durr grading system. Treatment efficacy was defined as freedom from HO re-formation requiring further surgical intervention. Efficacy and toxicity data were obtained from review of the medical records and were augmented by telephone interview of patients when possible (6 patients, all with follow-up >16 years). Efficacy rates by patient were estimated by the Kaplan-Meier method. RESULTS: The median follow-up after RT was 16.4 years (range, 2.5-19.2 years). Symptomatic re-formation of HO requiring further surgery occurred in 5 patients (7 joints). Treatment efficacy rates were 71% (95% confidence interval [CI], 44-99) at 5 years and 48% (95% CI, 15-80) at 10 years. Of the 6 patients contacted regarding late toxicity, 2 had clinical xerostomia (grade 1, CTCAE v3.0) attributable to RT; no other late RT-related toxicities were noted. None of the 12 patients had malignancy attributable to RT. CONCLUSIONS: Postoperative RT prevented re-formation of TMJ HO in 50% of treated patients long term. Late toxicities from RT were mild and infrequent.

Motion of the tympanic membrane after cartilage tympanoplasty determined by stroboscopic holography.

Stroboscopic holography was used to quantify dynamic deformations of the tympanic membrane (TM) of the entire surface of the TM before and after cartilage tympanoplasty of the posterior or posterior-superior part of the TM. Cartilage is widely used in tympanoplasties to provide mechanical stability for the TM. Three human cadaveric temporal bones were used. A 6 mm x 3 mm oval cartilage graft was placed through the widely opened facial recess onto the medial surface of the posterior or posterior-superior part of the TM. The graft was either in contact with the bony tympanic rim and manubrium or not. Graft thickness was either 0.5 or 1.0mm. Stroboscopic holography produced displacement amplitude and phase maps of the TM surface in response to stimulus sound. Sound stimuli were 0.5, 1, 4 and 7 (or 8)kHz tones. Middle-ear impedance was measured from the motion of the entire TM. Cartilage placement generally produced reductions in the motion of the TM apposed to the cartilage, especially at 4 kHz and 7 or 8 kHz. Some parts of the TM showed altered motion compared to the control in all three cases. In general, middle-ear impedance was either unchanged or increased somewhat after cartilage reconstruction both at low (0.5 and 1 kHz) and high (4 and 7 kHz) frequencies. At 4 kHz, with the 1.0mm thick graft that was in contact with the bony tympanic rim, the impedance slightly decreased. While our earlier work with time-averaged holography allowed us to observe differences in the pattern of TM motion caused by application of cartilage to the TM, stroboscopic holography is more sensitive to TM motions and allowed us to quantify the magnitude and phase of motion of each point on the TM surface. Nonetheless, our results are similar to those of our earlier work: The placement of cartilage on the medial surface of TM reduces the motion of the TM that apposes the cartilage. These obvious local changes occur even though the cartilage had little effect on the sound-induced motion of the stapes.

The diagnosis and treatment of nasal valve collapse.

PURPOSE OF REVIEW: The nasal valve is a complex structure that can be weakened from effects of aging, surgery, and trauma. A variety of methods have been described to strengthen the nasal valve region and prevent or treat nasal obstruction, such as batten grafts, spreader grafts, butterfly grafts, flare sutures, and suspension sutures. They will be briefly discussed here, but the intent of this review is to highlight the new developments in the treatment nasal valve collapse that have appeared in the literature over the last few years. RECENT FINDINGS: Various surgical techniques and approaches for addressing nasal valve collapse have been described in the literature. Still, new techniques continue to be developed and old techniques continue to be improved upon. More specifically, minimally invasive and endoscopic approaches are being developed and improvements are made on the use of graft materials. Finally, alternatives to surgery are explored for the treatment of nasal valve collapse. SUMMARY: The aim of the new advances in the treatment of nasal valve collapse is to maximize the benefit from the surgical intervention while minimizing disruption of the normal anatomy and physiology of the nose. Another trend in the new advances explores the nonsurgical options for the treatment of nasal valve collapse.

The fate of an amputated nose after replantation.

Traumatic amputation of the nose is a challenging management problem. We describe the case of a 69-year-old woman who had a dog-bite nasal amputation. The avulsed piece, including the lobule, and approximately half of the columella and alae, was replanted within 2 hours of the trauma. Hyperbaric oxygen therapy was administered for 12 daily sessions. Skin gradually necrosed, and the eschar was tangentially excised. Almost all of the mucosa and of the cartilage layers survived and the final defect was smaller than the original. A 3-stage repair was performed by a paramedian forehead flap to replace cover. Lining was by approximation of native tissues, whereas framework was reinforced by conchal and septal cartilage grafts. The outcome was functionally and aesthetically satisfactory. Our case confirms that replantation of an amputated nose as a composite graft is worthwhile. Although the skin necrosed and required reconstruction, most of the lining and of the cartilage support survived, greatly improving the ease of reconstruction, as well as nasal function.

Phenotypic analysis of bovine chondrocytes cultured in 3D collagen sponges: effect of serum substitutes.

Repair of damaged cartilage usually requires replacement tissue or substitute material. Tissue engineering is a promising means to produce replacement cartilage from autologous or allogeneic cell sources. Scaffolds provide a three-dimensional (3D) structure that is essential for chondrocyte function and synthesis of cartilage-specific matrix proteins (collagen type II, aggrecan) and sulfated proteoglycans. In this study, we assessed porous, 3D collagen sponges for in vitro engineering of cartilage in both standard and serum-free culture conditions. Bovine articular chondrocytes (bACs) cultured in 3D sponges accumulated and maintained cartilage matrix over 4 weeks, as assessed by quantitative measures of matrix content, synthesis, and gene expression. Chondrogenesis by bACs cultured with Nutridoma as a serum replacement was equivalent or better than control cultures in serum. In contrast, chondrogenesis in insulin-transferrin-selenium (ITS(+3)) serum replacement cultures was poor, apparently due to decreased cell survival. These data indicate that porous 3D collagen sponges maintain chondrocyte viability, shape, and synthetic activity by providing an environment favorable for high-density chondrogenesis. With quantitative assays for cartilage-specific gene expression and biochemical measures of chondrogenesis in these studies, we conclude that the collagen sponges have potential as a scaffold for cartilage tissue engineering.

The effectiveness of hyperbaric oxygen treatment in tracheal reconstruction with auricular cartilage grafts (experimental study).

PURPOSE: Tracheal stenosis or neoplastic changes, as well as, traumatic, congenital, or iatrogenic causes may require extensive tracheal resections. Complications like vascularization insufficiency and structural support problems occur nearly in all cases when end-to-end anastomosis of trachea is not feasible. Hyperbaric oxygen (HBO) treatment is a well-known method for the management of grafts and flaps that have vascularization problems. In this study, the effect of hyperbaric oxygen treatment on wound healing after tracheal reconstruction with auricular cartilage graft (ACG) has been evaluated. METHODS: Thirty-two rabbits were divided into 2 groups: study group (n = 16) and control group (n = 16). The anterior halves of the six tracheal rings were resected, and the defects were repaired with autogenic auricular grafts. Hyperbaric 100% pure oxygen was administered to the study group at 2.4 atmospheres of absolute pressure 2 times a day for 1 week. The control group did not receive any therapy except proper control of the wound. RESULTS: It was observed that in the study group, inflammation, fibrosis, and necrosis were less, whereas epithelialization and maturation were early and neovascularization and neochondrification were more than the control group only at specific weeks. But all tracheas in both groups showed excellent healing without graft rejection and excessive granulation tissue formation. Furthermore, there was no statistically difference between the 2 groups. CONCLUSIONS: Auricular cartilage grafts is a valuable management method of tracheal defects, and hyperbaric oxygen treatment is a good supplementary method in healing period of cartilage autografts.

[Mesenchymal stem cells--a new pathway for tissue engineering in reconstructive surgery]. / Adulte mesenchymale Stammzellen--neue Möglichkeiten der Gewebezüchtung für die plastisch-rekonstruktive Chirurgie. andreas.naumann@hno.med.uni-muenchen.de

INTRODUCTION: Mesenchymal stem cells (MSC) have the capacity to differentiate into chondrocytes with the synthesis of cartilage. This report presents the use of human adult bone marrow derived mesenchymal stem cells for tissue engineering of autologous cartilage grafts. METHODS: Human bone marrow aspirates were obtained from the iliac crest and fractionated on a Percoll gradient. The isolated hMSC were plated at 20 x 10 (6) cells per 100 mm (2) culture dish. After 21 days in culture at 37 degrees C with 5 % CO 2, the adherent multiplied MSC were trypsinized, counted, and tested for viability by trypan blue assay. The hMSCs were loaded into a sterile 15 ml polypropylene tube (0.5 Mio cells/ml) and centrifuged on the bottom of the tube at 500 g for 5 minutes. The MSC were cultivated for 3 weeks in vitro in a specific chondrogenetic medium composed of Dulbecco's Modified Eagles Medium-High Glucose supplemented with 10 ng/ml transforming growth factor-beta 1, 1 % ITS-Premix medium, 80 micro M ascorbic acid, and 100 nM dexamethasone. RESULTS: Histological and immunohistochemical studies performed after 3 weeks in three dimensional culture demonstrated the expression of cartilage specific collagen type II and X as well as proteoglycans. CONCLUSION: Human adult mesenchymal stem cells derived from bone marrow aspirates have the ability to differentiate into chondrocytes under specific culture conditions by growth factors. The use of adult mesenchymal stem cells may be a promising tool for tissue engineering of autologous cartilage grafts in reconstructive surgery in the future.