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

摘要

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.