title: A cell-free scaffold-based cartilage repair provides improved function hyaline-like repair at one year.
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.
  
  
  OBJECTIVE
  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.
  
  
  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.
  
  
  METHODS
  Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Struttura Complessa di Ortopedia e Traumatologia, Ospedale degli Infermi di Biella ASLBI, Str Cantone Rondolina 50, 13900 Biella, Piemonte, Italy. alsicl@libero.it
authors.forename: Alberto
authors.initials: A
authors.lastname: Siclari
authors.forename: Gennaro
authors.initials: G
authors.lastname: Mascaro
authors.forename: Chiara
authors.initials: C
authors.lastname: Gentili
authors.forename: Ranieri
authors.initials: R
authors.lastname: Cancedda
authors.forename: Eugenio
authors.initials: E
authors.lastname: Boux
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D054544:Arthroplasty, Subchondral / Q000379:methods*; D001182:Arthroscopy; D002358:Cartilage, Articular / Q000293:injuries*; D002474:Cell-Free System; D019902:Chondrocytes / Q000637:transplantation*; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use; D007150:Immunohistochemistry; D007718:Knee Injuries / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery; D010149:Postoperative Pain / Q000453:epidemiology; D053657:Platelet-Rich Plasma; D011100:Polyglycolic Acid / Q000627:therapeutic use; D011446:Prospective Studies; D011788:Quality of Life; D054457:Tissue Scaffolds
chemical_list: D011100:Polyglycolic Acid; D006820:Hyaluronic Acid