3D scaffolds in talus chondral lesions-ACI / fibrin glue scaffold versus type I collagen / hydroxyapatite scaffold

摘要

Chondral lesions do not heal in adult mature cartilage. Introduced in 1987 for large full thickness cartilage defects treatment, autologous cultured chondrocyte implantation (ACI) with cells in suspension showed promising results. With chondrografts of second and third ACI generation, the scaffold choice became the real issue. One of the disadvantages that has been pointed out about ACI procedure, is the need for a previous cartilage harvesting before implantation. In order to avoid this two-step surgery a new engineered type I collagen/ hydroxyapatite scaffold has recently been developed, which allows to address chondral lesions with a one-step procedure, laying an implant in place that will eventually be fulfilled with new cells arising form the subchondral bone. In this study we used both a 3D-solid fibrin glue scaffold with chondrocytes included inside the scaffold, and a type I collagen/ hydroxyapatite scaffold, on a number of different patients. In pre-clinical animal studies, both chondrocyte implantation using autologous cultured chondrocytes inside a solid fibrin-glue scaffold and the type I collagen/ hydroxyapatite scaffold proved to be a good solution for full thickness cartilage defects treatment. Seven patients with ages between 32 and 65 years-old were treated with either ACI or the collagen/ hydroxyapatite (HA) scaffold. All the four patients treated with ACI procedures had a clinical follow-up of more than five years, whereas the collagen/ HA scaffold patients had a mean follow-up of one and a half years. The final result seems to be age dependent. A second-look surgery was performed in two cases. In both cases it had been used the collagen/ hydroxyapatite scaffold. In one case there was a reactive synovitis and in the other an arthrofibrosis developed. In both cases arthroscopy showed complete cartilage coverage of the previous lesion. All the patients were retrospectively clinically assessed using Weber and Mazur ankle rating scales. Overall results showed good or excellent clinical results in all but one patient (85%), with 5 asymptomatic patients (72%) even in heavy work or in high sports level. The two symptomatic patients belong to the collagen/ hydroxyapatite scaffold group.