title: Cartilage repair in the knee with subchondral drilling augmented with a platelet-rich plasma-immersed polymer-based implant.
abstract: OBJECTIVE
  The aim of our study was to analyse the clinical and histological outcome after the treatment of focal cartilage defects in non-degenerative and degenerative knees with bone marrow stimulation and subsequent covering with a cell-free resorbable polyglycolic acid-hyaluronan (PGA-HA) implant immersed with autologous platelet-rich plasma (PRP).
  
  
  METHODS
  Fifty-two patients (mean age 44 years) with focal chondral defects in radiologically confirmed non-degenerative or degenerative knees were subjected to subchondral drilling arthroscopically. Subsequently, defects were covered with the PGA-HA implant immersed with autologous PRP. At 2-year follow-up, the patients' situation was assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and compared to the pre-operative situation and 3-12-month follow-up. Biopsies (n = 4) were harvested at 18-24 months after implantation and were analysed by histology and collagen type II immune staining.
  
  
  RESULTS
  At 1- and 2-year follow-up, the KOOS showed clinically meaningful and significant (p < 0.05) improvement in all subcategories compared to baseline and to 3-month follow-up. There were no differences in KOOS data obtained after 2 years compared to 1 year after the treatment. Histological analysis of the biopsy tissue showed hyaline-like to hyaline cartilage repair tissue that was rich in cells with a chondrocyte morphology, proteoglycans and type II collagen.
  
  
  CONCLUSIONS
  Covering of focal cartilage defects with the PGA-HA implant and PRP after bone marrow stimulation improves the patients' situation and has the potential to regenerate hyaline-like cartilage.
  
  
  METHODS
  Case series, Level IV.
authors.affiliation: Struttura Complessa di Ortopedia e Traumatologia, Ospedale degli Infermi di Biella ASLBI, Str. Cantone Rondolina 50, 13900, Piemonte, BI, 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: Christian
authors.initials: C
authors.lastname: Kaps
authors.forename: Ranieri
authors.initials: R
authors.lastname: Cancedda
authors.forename: Eugenio
authors.initials: E
authors.lastname: Boux
mesh_terms: D000328:Adult; D000368:Aged; D054544:Arthroplasty, Subchondral; D001672:Biocompatible Materials; D002358:Cartilage, Articular / Q000601:surgery; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage; D007718:Knee Injuries / Q000601:surgery*; D007719:Knee Joint / Q000601:surgery*; D007720:Knee Prosthesis; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery*; D053657:Platelet-Rich Plasma; D011100:Polyglycolic Acid / Q000008:administration & dosage
chemical_list: D001672:Biocompatible Materials; D011100:Polyglycolic Acid; D006820:Hyaluronic Acid
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