Fibrin glue improves osteochondral scaffold fixation: study on the human cadaveric knee exposed to continuous passive motion.
OBJECTIVE
To evaluate stability and integrity of bi-layer and three-layer collagen-hydroxyapatite (C-HA) osteochondral scaffolds in a human cadaveric knee exposed to continuous passive motion (CPM) with and without loading and the role of added fibrin glue to improve the press-fit fixation of C-HA scaffolds.


METHODS
Osteochondral lesions (2.0 × 1.5 cm) were chiseled out on both condyles and trochlea in eight human cadaveric knees. A total of 24 bi-layer (5 mm, four in each condyle) or three-layer C-HA scaffolds (8 mm, eight in the trochlea, four in each condyle) were first press-fit implanted and underwent testing with CPM, 90 cycles, 0°-90°. The second set of 24 scaffolds was implanted in cleaned lesions with the addition of fibrin glue. Two knees with fibrin glue fixation were additionally exposed to 15 kg loading, with 30 cycles of CPM, 0°-30°. Then, the knees were reopened and the scaffolds were evaluated using semi-quantitative Drobnic and modified Bekkers scores.


RESULTS
All but two scaffolds remained in the lesions site throughout CPM. Two implants failed: both were bi-layer osteochondral scaffolds, press-fit implanted at the lateral femoral condyle (LFC). A statistically significant difference was obtained between press-fit and fibrin glue implants with both Drobnic (2.9 ± 0.7 vs 4.3 ± 0.1, P < 0.0005) and Bekkers (3.3 ± 1.0 vs 5.0 ± 0.1, P < 0.0005) scores. Additional knee loading did not affect fibrin glue scaffold fixation or integrity.


CONCLUSIONS
This cadaveric study showed fibrin glue notably improved bi-layer or three-layer C-HA scaffold press-fit fixation regardless of lesion location. It is therefore recommended that fibrin glue be used during surgery to improve early post-operative C-HA scaffold stability and integrity.
Nano-Biotechnology Laboratory, II Orthopaedic Clinic, Rizzoli Orthopaedic Institute, Bologna, Italy.
G
G
Filardo
Orthopaedic Clinic, Medical Faculty, University of Ljubljana, Slovenia.
M
M
Drobnic
Biomechanics Laboratory, II Orthopaedic Clinic, Rizzoli Orthopaedic Institute, Bologna, Italy.
F
F
Perdisa
Nano-Biotechnology Laboratory, II Orthopaedic Clinic, Rizzoli Orthopaedic Institute, Bologna, Italy. Electronic address: e.kon@biomec.ior.it.
E
E
Kon
Institute of Anatomy, Medical Faculty, University of Ljubljana, Slovenia.
M
M
Hribernik
Biomechanics Laboratory, II Orthopaedic Clinic, Rizzoli Orthopaedic Institute, Bologna, Italy.
M
M
Marcacci
D001672:Biocompatible Materials / Q000627:therapeutic use; D002102:Cadaver; D002358:Cartilage, Articular / Q000601:surgery*; D019902:Chondrocytes; D003094:Collagen / Q000627:therapeutic use; D017886:Durapatite / Q000627:therapeutic use; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D009068:Movement; D011475:Prosthesis Failure; D016059:Range of Motion, Articular; D013314:Stress, Mechanical; D014014:Tissue Adhesives / Q000627:therapeutic use*; D054457:Tissue Scaffolds / Q000592:standards*; D016896:Treatment Outcome
D001672:Biocompatible Materials; D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives; D003094:Collagen; D017886:Durapatite
Articular cartilage lesion; Fibrin glue; Knee joint; Osteochondral scaffold; Post-operative rehabilitation; Scaffold fixation