title: Surgical treatment of early knee osteoarthritis with a cell-free osteochondral scaffold: results at 24 months of follow-up.
abstract: OBJECTIVE
  "Early Osteoarthritis (EOA)" has been defined combining clinical, imaging and surgical parameters, with the aim to identify patients in early degenerative phases, who might benefit from the use of available regenerative procedures. Aim of this first clinical trial is to prospectively evaluate the results obtained in a group of patients meeting the inclusion criteria of "EOA" as proposed by the ESSKA Cartilage Committee, and surgically treated with the implantation of a multi-phasic osteochondral scaffold.
  
  
  METHODS
  23 patients were prospectively evaluated at 12 and 24 months of follow-up. Etiology of the chondral or osteochondral defect was rated as microtraumatic or degenerative in 18 cases, and traumatic in 5 cases. Patients included were complaining of clinical symptoms like knee pain and affected by chondral and osteochondral lesions located at the femoral condyles or trochlea and MRI findings demonstrating articular cartilage degeneration and/or meniscal degeneration and/or subchondral bone marrow lesions.
  
  
  RESULTS
  All patients increased significantly in any clinical score adopted. The IKDC subjective score increased from 42.8 ± 13.8 at basal evaluation to 74.3 ± 17.4 at 12 months' (p < 0.0005), being stable (74.9 ± 20.4) up to the final follow-up of 24 months. Tegner score showed a statistically significant improvement in sports activity from 3.3 ± 2.7 pre-operative to 4.6 ± 2.2 at 12 months (p < 0.005), with a slight improvement to the final evaluation (4.7 ± 2.1; n.s.). However, the activity level was significantly lower than the pre-injury one (6.1 ± 2.6; p = 0.004). A significant difference was shown between patients younger versus older than 40 years, with younger patients had better clinical improvement (76.0 ± 18.6 vs 45.1 ± 38.8 respectively, p = 0.037).
  
  
  CONCLUSIONS
  The implantation of a multi-phasic osteochondral scaffold represents a good option after failure of conservative management for Early OA patients, where younger age represent an important factor for a better outcome. Longer follow-up is needed to evaluate the benefit over time.
  
  
  METHODS
  IV, case series.
authors.affiliation: II Clinic, Biomechanics Laboratory, Rizzoli Orthopaedic Institute, Bologna, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Di Martino
authors.affiliation: II Clinic, Biomechanics Laboratory, Rizzoli Orthopaedic Institute, Bologna, Italy. Electronic address: e.kon@biomec.ior.it.
authors.forename: Elizaveta
authors.initials: E
authors.lastname: Kon
authors.affiliation: II Clinic, Biomechanics Laboratory, Rizzoli Orthopaedic Institute, Bologna, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Perdisa
authors.affiliation: II Clinic, Biomechanics Laboratory, Rizzoli Orthopaedic Institute, Bologna, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Sessa
authors.affiliation: II Clinic, Biomechanics Laboratory, Rizzoli Orthopaedic Institute, Bologna, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Filardo
authors.affiliation: II Clinic, Biomechanics Laboratory, Rizzoli Orthopaedic Institute, Bologna, Italy.
authors.forename: Maria Pia
authors.initials: MP
authors.lastname: Neri
authors.affiliation: Biomechanics Laboratory, Rizzoli Orthopaedic Institute, Bologna, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Bragonzoni
authors.affiliation: II Clinic, Biomechanics Laboratory, Rizzoli Orthopaedic Institute, Bologna, Italy.
authors.forename: Maurilio
authors.initials: M
authors.lastname: Marcacci
mesh_terms: D000368:Aged; D040761:Biomimetic Materials; D002358:Cartilage, Articular / Q000166:cytology*; D005260:Female; D005500:Follow-Up Studies; D048091:Guided Tissue Regeneration / Q000379:methods*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007719:Knee Joint / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D010147:Pain Measurement; D011446:Prospective Studies; D054457:Tissue Scaffolds; D016896:Treatment Outcome
keywords: Osteochondral; acellular scaffold; degenerative; early osteoarthritis