Clinical Orthopaedics and Related Research®

, Volume 470, Issue 3, pp 910–919 | Cite as

A Cell-free Scaffold-based Cartilage Repair Provides Improved Function Hyaline-like Repair at One year

  • Alberto SiclariEmail author
  • Gennaro Mascaro
  • Chiara Gentili
  • Ranieri Cancedda
  • Eugenio Boux
Clinical Research



Bone marrow stimulation techniques in cartilage repair such as drilling are limited by the formation of fibrous to hyaline-like repair tissue. It has been suggested such techniques can be enhanced by covering the defect with scaffolds. We present an innovative approach using a polyglycolic acid (PGA)-hyaluronan scaffold with platelet-rich-plasma (PRP) in drilling.


We asked whether (1) PRP immersed in a cell-free PGA-hyaluronan scaffold improves patient-reported 1-year outcomes for the Knee injury and Osteoarthritis Score (KOOS), and (2) implantation of the scaffold in combination with bone marrow stimulation leads to the formation of hyaline-like cartilage repair tissue.

Patients and Methods

We reviewed 52 patients who had arthroscopic implantation of the PGA-hyaluronan scaffold immersed with PRP in articular cartilage defects of the knee pretreated with Pridie drilling. Patients were assessed by KOOS. At 9 months followup, histologic staining was performed in specimens obtained from five patients to assess the repair tissue quality.


The KOOS subscores improved for pain (55 to 91), symptoms (57 to 88), activities of daily living (69 to 86), sports and recreation (36 to 70), and quality of life (38 to 73). The histologic evaluation showed a homogeneous hyaline-like cartilage repair tissue.


The cell-free PGA-hyaluronan scaffold combined with PRP leads to cartilage repair and improved patient-reported outcomes (KOOS) during 12 months of followup. Histologic sections showed morphologic features of hyaline-like repair tissue. Long-term followup is needed to determine if the cartilage repair tissue is durable.

Level of Evidence

Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.


Repair Tissue Cartilage Defect Cartilage Repair Autologous Chondrocyte Implantation International Knee Documentation Committee 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We thank D. Confalone (DC) MD for interpreting the MRIs to assess defect filling, effusion, and bone marrow edema.


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Copyright information

© The Association of Bone and Joint Surgeons® 2011

Authors and Affiliations

  • Alberto Siclari
    • 1
    Email author
  • Gennaro Mascaro
    • 2
  • Chiara Gentili
    • 3
  • Ranieri Cancedda
    • 4
  • Eugenio Boux
    • 1
  1. 1.Struttura Complessa di Ortopedia e TraumatologiaOspedale degli Infermi di Biella ASLBIBiellaItaly
  2. 2.Servizio di Immunoematologia e Medicina TrasfusionaleOspedale degli Infermi di Biella ASLBIBiellaItaly
  3. 3.Istituto Nazionale per la Ricerca sul CancroGenovaItaly
  4. 4.Dipartimento di Oncologia, Biologia e GeneticaUniversità di Genova & Istituto Nazionale per la Ricerca sul CancroGenovaItaly

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