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Chitosan based scaffold applied in patellar cartilage lesions showed positive clinical and MRI results at minimum 2 years of follow up

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

New scaffold-based cartilage regeneration techniques have been developed to improve the results of microfractures also in complex locations like the patello-femoral joint. The aim of this study was to analyse the results obtained in patellar lesions treated with a bioscaffold,  a mixture composed by a chitosan solution, a buffer, and the patient’s whole blood  which forms a stable clot into the lesion.

Methods

Fifteen patients with ICRS grade 3–4 cartilage lesions of the patellar surface were treated with a chitosan bioscaffold. Fourteen patients were clinically and radiologically evaluated prospectively for a minimum follow-up of 2 years with IKDC, KOOS, Tegner score, and MRI. The mean age of patients at the time of surgery was 31.8 ± 11.9 and nine patients presented degenerative aetiology, four patients with previous trauma, and 1 patient with osteochondritis dissecans. 

Results

The IKDC subjective score improved from 46.2 ± 19.3 preoperatively to 69.5 ± 20.3 (p < 0.05) and 74.1 ± 23.2 (p < 0.05) at 12 and 24 months, respectively. Also KOOS Pain, KOOS Sport/Rec and KOOS QOL showed a significant improvement from baseline to 12 months and to the final follow-up. MRI evaluation showed a complete filling of the cartilage defect at the final follow-up in 70% of the lesions, obtaining a total MOCART 2.0 score of 71.5 ± 13.6 at 24 months after surgery.

Conclusion

Chondral patellar lesions represent a complex pathology, with lower results compared to other sites. This bioscaffold represents a safe surgical treatment providing a significant clinical improvement at 24 months in the treatment of patellar cartilage lesions.

Level of evidence

IV.

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Acknowledgements

The authors would like to acknowledge Elettra Pignotti for her contribution with the statistical analysis.

Funding

This study received financial support by the “Piramal healthcare (CANADA) LTD”.

Author information

Author notes

  1. Alberto Poggi and Alessandro Di Martino have contributed equally to this article.

Authors and Affiliations

  1. Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy

    Alberto Poggi, Alessandro Di Martino, Luca Andriolo, Davide Reale & Stefano Zaffagnini

  2. Applied and Translational Research (ATR) Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy

    Giuseppe Filardo

  3. Humanitas Clinical and Research Center – IRCCS, via Manzoni 56, 20089, Rozzano (Mi), Italy

    Elizaveta Kon

  4. Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele (Mi), Italy

    Elizaveta Kon

Authors
  1. Alberto Poggi
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  2. Alessandro Di Martino
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  3. Luca Andriolo
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  4. Davide Reale
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  5. Giuseppe Filardo
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  6. Elizaveta Kon
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  7. Stefano Zaffagnini
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Contributions

SZ and EK: conceptualisation; GF and EK: methodology; AP, DR: data curation; AP, DR and LA: writing—original draft preparation; LA, GF, ADM: writing—review and editing, SZ, EK, GF, ADM: supervision. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Luca Andriolo.

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Conflict of interest

SZ consultant surgeon for Smith & Nephew and DePuy Synthes. EK reports consulting for Carihealldt, Green Bone, Geistlich, and Bioveex, and speaking for Zimmer Biomet and Fidia Farmaceutici SPA. These funders had no role in the design of the study, in the collection, analyses, or interpretation of data, in the writing of the manuscript, or in the decision to publish the results. The other authors declare no conflict of interest.

Ethical approval

This pilot study was approved by the Hospital Ethics Committee of the Rizzoli Orthopaedic Institute, Bologna, Italy (protocol number 0019704). The trial was registered at clinicaltrials.gov and was entirely conducted in a highly specialised referral centre for orthopaedic pathologies.

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Poggi, A., Di Martino, A., Andriolo, L. et al. Chitosan based scaffold applied in patellar cartilage lesions showed positive clinical and MRI results at minimum 2 years of follow up. Knee Surg Sports Traumatol Arthrosc 31, 1714–1722 (2023). https://doi.org/10.1007/s00167-022-07023-1

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