Skip to main content
SpringerLink
Log in

Use of innovative biomimetic scaffold in the treatment for large osteochondral lesions of the knee

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Large osteochondral defects involve two different tissues characterized by different intrinsic healing capacity. Different techniques have been proposed to treat these lesions with results still under discussion. The aim of the study is to evaluate the clinical outcome of 19 patients treated with a type I collagen–hydroxyapatite nanostructural biomimetic osteochondral scaffold at minimum follow-up of 2 years.

Methods

Twenty lesions, 19 patients were treated with this scaffold implantation. The lesions size went from 4 to 8 cm2 (mean size 5.2 ± 1.6 cm2). All patients were clinically evaluated using the International Repair Cartilage Society score, the Tegner Score and EQ-VAS. MRI was performed at 12 and 24 months after surgery and then every 12 months and evaluated with magnetic resonance observation of cartilage repair tissue scoring scale.

Results

The IKDC subjective score improved from a mean score of 35.7 ± 6.3 at the baseline evaluation to 67.7 ± 13.4 at 12-month follow-up (p < 0.0005). A further improvement was documented from 12 to 24 months (mean score of 72.9 ± 12.4 at 24 months) (p < 0.0005). The IKDC objective score confirmed the results. The Tegner activity score improvement was statistically significant (p < 0.0005). The EQ-VAS showed a significant improvement from 3.15 ± 1.09 to 7.35 ± 1.14 (p < 0.0005) at 2-year follow-up. The lesion’ site seems to influence the results showing a better outcome in the patients affected in the medial femoral condyle.

Conclusions

The use of the MaioRegen scaffold is a good procedure for the treatment for large osteochondral defects where other classic techniques are difficult to apply. It is an open one-step surgery with promising stable results at medium follow-up.

Level of evidence

IV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Bartlett W, Gooding CR, Carrington RW, Skinner JA, Briggs TW, Bentley G (2005) Autologous chondrocyte implantation at the knee using a bilayer collagen membrane with bone graft. A preliminary report. J Bone Joint Surg Br 87(3):330–332

    Article  CAS  PubMed  Google Scholar 

  2. Benthien JP, Behrens P (2011) The treatment of chondral and osteochondral defects of the knee with autologous matrix-induced chondrogenesis (AMIC): method description and recent developments. Knee Surg Sports Traumatol Arthrosc 19(8):1316–1319

    Article  PubMed  Google Scholar 

  3. Buda R, Vannini F, Cavallo M, Grigolo B, Cenacchi A, Giannini S (2010) Osteochondral lesions of the knee: a new one step repair technique with bone marrow derived cells. J Bone Joint Surg Am 92(Suppl 2):2–11

    Article  PubMed  Google Scholar 

  4. Carmont MR, Carey-Smith R, Saithna A, Dhillon M, Thompson P, Spalding T (2009) Delayed incorporation of a TruFit plug: perseverance is recommended. Arthroscopy 25(7):810–814

    Article  PubMed  Google Scholar 

  5. Deponti D, Di Giancamillo A, Mangiavini L, Pozzi A, Fraschini G, Sosio C, Domeneghini C, Peretti (2012) Fibrin-based model for cartilage regeneration: tissue maturation from in vitro to in vivo. Tissue Eng Part A 18(11–12):1109–1122

    Article  CAS  PubMed  Google Scholar 

  6. Dhollander AA, Liekens K, Almqvist KF, Verdonk R, Lambrecht S, Elewaut D, Verbruggen G, Verdonk PC (2012) A pilot study of the use of an osteochondral scaffold plug for cartilage repair in the knee and how to deal with early clinical failures. Arthroscopy 28(2):225–233

    Article  PubMed  Google Scholar 

  7. Dhollander AA, Verdonk PC, Lambrecht S, Verdonk R, Elewaut D, Verbruggen G, Almqvist KF (2012) Midterm results of the treatment of cartilage defects in the knee using alginate beads containing human mature allogenic chondrocytes. Am J Sports Med 40(1):75–82

    Article  PubMed  Google Scholar 

  8. Dhollander AM, Verdonk P, Lambrecht S, Verdonk R, Elewaut D, Verbruggen G, Almqvist KF (2012) Short-term outcome of the second generation characterized chondrocyte implantation for the treatment of cartilage lesions in the knee. Knee Surg Sports Traumatol Arthrosc 20(6):1118–1127

    Article  CAS  PubMed  Google Scholar 

  9. Emmerson BC, Görtz S, Jamali AA, Chung C, Amiel D, Bugbee WD (2007) Fresh osteochondral allografting in the treatment of osteochondritis dissecans of the femoral condyle. Am J Sports Med 35(6):907–914

    Article  PubMed  Google Scholar 

  10. Filardo G, Kon E, Berruto M, Di Martino A, Patella S, Marcheggiani Muccioli GM, Zaffagnini S, Marcacci M (2012) Arthroscopic second generation autologous chondrocytes implantation associated with bone grafting for the treatment of knee osteochondritis dissecans: results at 6 years. Knee 19(5):658–663

    Article  PubMed  Google Scholar 

  11. Filardo G, Kon E, Roffi A, Di Martino A, Marcacci M (2013) Scaffold-based repair for cartilage healing: a systematic review and technical note. Arthroscopy 29(1):174–186

    Article  PubMed  Google Scholar 

  12. Gillogly SD, Myers TH (2005) Treatment of full-thickness chondral defects with autologous chondrocyte implantation. Orthop Clin North Am 36(4):433–446

    Article  PubMed  Google Scholar 

  13. Gomoll AH, Filardo G, Kon E et al (2012) Surgical treatment for early osteoarthritis. Part I: cartilage repair procedures. Knee Surg Sports Tramatol Arthrosc 20:450–466

    Article  CAS  Google Scholar 

  14. Gomoll AH, Filardo G, Marcacci M et al (2012) Surgical treatment for early osteoarthritis. Part II: allografts and concurrent procedures. Knee Surg Sports Tramatol Arthrosc 20:468–486

    Article  CAS  Google Scholar 

  15. Görtz S, De Young AJ, Bugbee WD (2010) Fresh osteochondral allografting for steroid-associated osteonecrosis of the femoral condyles. Clin Orthop Relat Res 468:1269–1278

    Article  PubMed Central  PubMed  Google Scholar 

  16. Hangody L, Dobos J, Baló E, Pánics G, Hangody LR, Berkes I (2010) Clinical experiences with autologous osteochondral mosaicplasty in an athletic population: a 17-year prospective multicenter study. Am J Sports Med 38(6):1125–1133

    Article  PubMed  Google Scholar 

  17. Hjelle K, Solheim E, Strand T, Muri R, Brittberg M (2002) Articular cartilage defects in 1,000 knee arthroscopies. Arthroscopy 18(7):730–734

    Article  PubMed  Google Scholar 

  18. Kon E, Delcogliano M, Filardo G, Busacca M, Di Martino A, Marcacci M (2011) Novel composite multilayered biomaterial for osteochondral regeneration: a pilot clinical trial. Am J Sports Med 39(6):1180–1190

    Article  PubMed  Google Scholar 

  19. Kon E, Delcogliano M, Filardo G, Fini M, Giavaresi G, Francioli S, Martin I, Pressato D, Arcangeli E, Quarto R, Sandri M, Marcacci M (2010) Orderly osteochondral regeneration in sheep model using a novel nano-composite multilayered biomaterial. J Orthop Res 28(1):116–1124

    PubMed  Google Scholar 

  20. Kon E, Delcogliano M, Filardo G, Pressato D, Busacca M, Grigolo B, Desando G, Marcacci M (2010) A novel nano-composite multi-layered biomaterial for treatment of osteochondral lesions: technique note and an early stability pilot clinical trial. Injury 41(7):693–701

    Article  CAS  PubMed  Google Scholar 

  21. Kon E, Mutini A, Arcangeli E, Delcogliano M, Filardo G, Nicoli Aldini N, Pressato D, Quarto R, Zaffagnini S, Marcacci M (2010) Novel nanostructured scaffold for osteochondral regeneration: a pilot study in horses. J Tissue Eng Regen Med 4(4):300–308

    Article  CAS  PubMed  Google Scholar 

  22. Kon E, Vannini F, Buda R, Filardo G, Cavallo M, Ruffilli A, Nanni M, Di Martino A, Marcacci M, Giannini S (2012) How to treat osteochondritis dissecans of the knee: surgical techniques and new trends: AAOS exhibit selection. J Bone Joint Surg Am 4;94(1):e1(1–8)

    Google Scholar 

  23. Könst YE, Benink RJ, Veldstra R, van der Krieke TJ, Helder MN, van Royen BJ (2012) Treatment of severe osteochondral defects of the knee by combined autologous bone grafting and autologous chondrocyte implantation using fibrin gel. Knee Surg Sports Traumatol Arthrosc 20(11):2263–2269

    Article  PubMed Central  PubMed  Google Scholar 

  24. Krishnan SP, Skinner JA, Carrington RW, Flanagan AM, Briggs TW, Bentley G (2006) Collagen-covered autologous chondrocyte implantation for osteochondritis dissecans of the knee: two-to seven-year results. J Bone Joint Surg Br 88(2):203–205

    Article  CAS  PubMed  Google Scholar 

  25. Marcacci M, Zaffagnini S, Kon E, Marcheggiani Muccioli GM, Di Martino A, Di Matteo B, Bonanzinga T, Iacono F, Filardo G (2013) Unicompartmental osteoarthritis: an integrated biomechanical and biological approach as alternative to metal resurfacing. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-013-2388-0

    Google Scholar 

  26. Marlovits S, Striessnig G, Resinger CT et al (2004) Definition of pertinent parameters for the evaluation of articular cartilage repair tissue with high-resolution magnetic resonance imaging. Eur J Radiol 52:310–319

    Article  PubMed  Google Scholar 

  27. Marmotti A, Bruzzone M, Bonasia DE, Castoldi F, Rossi R, Piras L, Maiello A, Realmuto C, Peretti GM (2012) One-step osteochondral repair with cartilage fragments in a composite scaffold. Knee Surg Sports Traumatol Arthrosc 20(12):2590–2601

    Article  CAS  PubMed  Google Scholar 

  28. Martin I, Miot S, Barbero A, Jakob M, Wend D (2007) Osteochondral tissue engineering. J Biomech 40(4):750–765

    Article  PubMed  Google Scholar 

  29. Minas T, Peterson L (1999) Advanced techniques in autologous chondrocyte transplantation. Clin Sports Med 18(1):13–44

    Article  CAS  PubMed  Google Scholar 

  30. Nesic D, Whiteside R, Brittberg M, Wendt D, Martin I, Mainil-Varlet P (2006) Cartilage tissue engineering for degenerative joint disease. Adv Drug Deliv Rev 58(2):300–322

    Article  CAS  PubMed  Google Scholar 

  31. Ochs BG, Müller-Horvat C, Albrecht D, Schewe B, Weise K, Aicher WK, Rolauffs B (2011) Remodeling of articular cartilage and subchondral bone after bone grafting and matrix-associated autologous chondrocyte implantation for osteochondritis dissecans of the knee. Am J Sports Med 39(4):764–773

    Article  PubMed  Google Scholar 

  32. Pallante AL, Bae WC, Chen AC, Görtz S, Bugbee WD, Sah RL (2009) Chondrocyte viability is higher after prolonged storage at 37 °C than at 4 °C for osteochondral grafts. Am J Sports Med 37(Suppl 1):24S–32S

    Article  PubMed Central  PubMed  Google Scholar 

  33. Peterson L (2003) Chondrocyte transplantation. In: Jackson DW (ed) Master techniques in orthopaedic surgery: reconstructive knee surgery. Lippincott Williams & Wilkins, Philadelphia, pp 353–373

  34. Peterson L, Minas T, Brittberg M, Nilsson A, Sjögren-Jansson E, Lindahl A (2000) Two- to 9-year outcome after autologous chondrocyte transplantation of the knee. Clin Orthop Relat Res 374:212–234

    Article  PubMed  Google Scholar 

  35. Peterson L, Vasiliadis HS, Brittberg M, Lindhal A (2010) Autologous chondrocyte implantation: a long-term follow-up. Am J Sports Med 38(6):1117–1124

    Article  PubMed  Google Scholar 

  36. Tampieri A, Sandri M, Landi E, Pressato D, Francioli S, Quarto R, Martin I (2008) Design of graded biomimetic osteochondral composite scaffolds. Biomaterials 29(26):3539–3546

    Article  CAS  PubMed  Google Scholar 

  37. Ventura A, Memeo A, Borgo E, Terzaghi C, Legnani C, Albisetti W (2012) Repair of osteochondral lesions in the knee by chondrocyte implantation using the MACI® technique. Knee Surg Sports Traumatol Arthrosc 20(1):121–126

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

All procedures performed were approved by the Ethical Committee of our hospital. Informed consent was obtained in all patients.

Author information

Authors and Affiliations

  1. University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy

    Marco Delcogliano, Francesca de Caro, Edoardo Scaravella, Giovanni Ziveri, Carlo Felice De Biase & Pietro Marenghi

  2. San Carlo-IDI Hospital, Via Aurelia 275, 00165, Rome, Italy

    Domenico Marotta & Antonio Delcogliano

Authors
  1. Marco Delcogliano
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Francesca de Caro
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Edoardo Scaravella
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Giovanni Ziveri
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Carlo Felice De Biase
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Domenico Marotta
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Pietro Marenghi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Antonio Delcogliano
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Francesca de Caro.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Delcogliano, M., de Caro, F., Scaravella, E. et al. Use of innovative biomimetic scaffold in the treatment for large osteochondral lesions of the knee. Knee Surg Sports Traumatol Arthrosc 22, 1260–1269 (2014). https://doi.org/10.1007/s00167-013-2717-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-013-2717-3

Keywords

Search

Navigation