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Clinical and radiographic outcomes of chitosan-glycerol phosphate/blood implant are similar with hyaluronic acid-based cell-free scaffold in the treatment of focal osteochondral lesions of the knee joint

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

Abstract

Purpose

To determine the clinical and radiographic efficacy of chitosan-glycerol phosphate/blood implant versus hyaluronic acid-based cell-free scaffold in patients with focal osteochondral lesion of the knee joint.

Methods

Clinical data of 46 patients surgically treated using either chitosan-glycerol phosphate/blood implant (25 patients, Group 1) or hyaluronic acid-based cell-free scaffold (21 patients, Group 2) in combination with microfracture were retrospectively evaluated. All lesions were Outerbridge grade III or IV with a mean lesion size of 3.3 ± 0.7 cm2. The mean follow-up time was 24.4 months. Visual analogue scale (VAS), Lysholm knee score, and Tegner activity scale were the instruments to evaluate the clinical status. Magnetic resonance observation of cartilage repair tissue (MOCART) system was used to analyze the characteristics of repair tissue.

Results

No significant differences were detected between the groups regarding VAS, Lysholm, and Tegner scores at any time interval during the whole follow-up. The mean post-operative VAS and Lysholm scores at the latest follow-up was significantly better in cases with the lesion size ≤ 3 cm2 in Group 1 (p = 0.001, p < 0.001, respectively). However, no significant differences according to the lesion size were detected in Group 2 (n.s.). Complete repair with the filling of the defect was achieved in 7 (28%) of the knees in Group 1 and it was 7 (33.3%) of the knees in Group 2 according to MOCART system at the latest follow-up.

Conclusion

Single-stage regenerative cartilage surgery using chitosan-glycerol phosphate/blood implant combined to microfracture for focal osteochondral lesions of the knee revealed similar clinical and radiographic outcomes with hyaluronic acid-based cell-free scaffold at short-term follow-up. However, clinical outcomes of hyaluronan scaffold were less sensitive to defect size than chitosan. With the advantages of no hypertrophic repair tissue formation as well as no need to arthrotomy during surgery, chitosan is an effective choice especially in patients with the lesion size ≤ 3 cm2.

Level of evidence

III.

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Funding

The authors declare that there was no funding of this study.

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Authors and Affiliations

  1. Erzincan University Faculty of Medicine, Basbaglar mahallesi No 1, 24030, Erzincan, Turkey

    Hakan Sofu, Yalkin Camurcu, Seckin Ozcan, Hakan Yurten & Vedat Sahin

  2. Mengucekgazi Education and Research Hospital, Erzincan, Turkey

    Hanifi Ucpunar

Authors
  1. Hakan Sofu
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  2. Yalkin Camurcu
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  3. Hanifi Ucpunar
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  4. Seckin Ozcan
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Corresponding author

Correspondence to Hakan Sofu.

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The authors declare that they have no conflict of interest.

Ethical approval

This study was conducted in compliance with ethical standards after having IRB approval.

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Sofu, H., Camurcu, Y., Ucpunar, H. et al. Clinical and radiographic outcomes of chitosan-glycerol phosphate/blood implant are similar with hyaluronic acid-based cell-free scaffold in the treatment of focal osteochondral lesions of the knee joint. Knee Surg Sports Traumatol Arthrosc 27, 773–781 (2019). https://doi.org/10.1007/s00167-018-5079-z

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