Patellofemoral full-thickness chondral defects treated with Hyalograft-C: a clinical, arthroscopic, and histologic review.
BACKGROUND
Tissue engineering has emerged as a potential therapeutic option for cartilage regeneration.


OBJECTIVE
Hyaluronan-based scaffolds seeded with autologous chondrocytes are a viable treatment for damaged articular surface of the patellofemoral joint.


METHODS
Case series; Level of evidence, 4.


METHODS
Thirty-two chondral lesions with a mean size of 4.7 cm(2) were treated with Hyalograft-C. Twenty-two lesions were located in the patella and 10 in the trochlea. Sixteen patients had previous trauma, 3 had osteochondritis dissecans, and 13 had degenerative changes. Transplantations were carried out arthroscopically or through a miniarthrotomy incision. Eight patients had concomitant procedures, including patellar realignment (2), lateral release (3), and meniscectomy (3). Results were evaluated using the International Cartilage Repair Society-International Knee Documentation Committee scale, EuroQol EQ-5D form, and magnetic resonance imaging scans at 12 and 24 months. Six patients had second-look arthroscopy and biopsies. Statistical analysis was performed using the paired t test and Wilcoxon signed rank test.


RESULTS
The International Cartilage Repair Society-International Knee Documentation Committee and EuroQol EQ-5D scores demonstrated a statistically significant improvement (P < .0001). Objective preoperative data improved from 6/32 (18.8%) with International Knee Documentation Committee A or B to 29/32 (90.7%) at 24 months after transplantation. Mean subjective scores improved from 43.2 points preoperatively to 73.6 points 24 months after implantation. Magnetic resonance imaging studies at 24 months revealed 71% to have an almost normal cartilage with positive correlation to clinical outcomes. Second-look arthroscopies in 6 cases revealed the repaired surface to be nearly normal with biopsy samples characterized as hyaline-like in appearance.


CONCLUSIONS
Biodegradable scaffolds seeded with autologous chondrocytes can be a viable treatment for chondral lesions. The type of tissue repair achieved demonstrated histologic characteristics similar to normal articular cartilage. Long-term investigations are needed to determine the durability of the repair produced with this technique.
Gobbi
Alberto
A
Orthopaedic Arthroscopic Surgery International, Milan, Italy. sportmd@tin.it
Kon
Elisaveta
E
Berruto
Massimo
M
Francisco
Ramces
R
Filardo
Giuseppe
G
Marcacci
Maurilio
M
D000276:Adjuvants, Immunologic / Q000627:therapeutic use*; D000293:Adolescent; D000328:Adult; D001182:Arthroscopy; D001706:Biopsy; D002358:Cartilage, Articular / Q000293:injuries* / Q000473:pathology / Q000502:physiology; D019902:Chondrocytes / Q000637:transplantation*; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use*; D007718:Knee Injuries / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000628:therapy; D010008:Osteochondritis Dissecans / Q000628:therapy; D010147:Pain Measurement; D011446:Prospective Studies; D020127:Recovery of Function; D012038:Regeneration; D024162:Second-Look Surgery; D023822:Tissue Engineering / Q000379:methods*; D014182:Transplantation, Autologous
D000276:Adjuvants, Immunologic; D006820:Hyaluronic Acid