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

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

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.

Questions/purposes

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.

Results

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.

Conclusions

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.

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Acknowledgments

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

Author information

Authors and Affiliations

  1. Struttura Complessa di Ortopedia e Traumatologia, Ospedale degli Infermi di Biella ASLBI, Str. Cantone Rondolina 50, 13900, Biella, Piemonte, Italy

    Alberto Siclari MD & Eugenio Boux MD

  2. Servizio di Immunoematologia e Medicina Trasfusionale, Ospedale degli Infermi di Biella ASLBI, Biella, Italy

    Gennaro Mascaro MD

  3. Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy

    Chiara Gentili MD

  4. Dipartimento di Oncologia, Biologia e Genetica, Università di Genova & Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy

    Ranieri Cancedda PhD

Authors
  1. Alberto Siclari MD
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  2. Gennaro Mascaro MD
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  3. Chiara Gentili MD
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  4. Ranieri Cancedda PhD
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  5. Eugenio Boux MD
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Corresponding author

Correspondence to Alberto Siclari MD.

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Each author certifies that he or she has no commercial associations that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopedics and Related Research editors and board members are on file with the publication and can be reviewed upon request.

Each author certifies that his or her institution approved the human protocol for this investigation that all investigations were conducted in conformity with ethical principles of research and that informed consent for participation in the study was obtained.

This work was performed at Ospedale degli Infermi di Biella ASLBI.

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Siclari, A., Mascaro, G., Gentili, C. et al. A Cell-free Scaffold-based Cartilage Repair Provides Improved Function Hyaline-like Repair at One year. Clin Orthop Relat Res 470, 910–919 (2012). https://doi.org/10.1007/s11999-011-2107-4

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  • DOI: https://doi.org/10.1007/s11999-011-2107-4

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