Results of Hyaluronic Acid-Based Cell-Free Scaffold Application in Combination With Microfracture for the Treatment of Osteochondral Lesions of the Knee: 2-Year Comparative Study.
OBJECTIVE
To determine the clinical and radiographic efficacy of hyaluronic acid-based cell-free scaffold applied in combination with microfracture versus microfracture alone in patients with focal osteochondral lesion of the knee joint.


METHODS
Clinical data of 43 patients between 24 and 55 years of age were evaluated. Hyaluronic acid-based cell-free scaffold was applied in combination with microfracture for 19 knees (group 1), whereas microfracture alone was the surgical intervention for 24 knees (group 2). All lesions were Outerbridge grade III or IV with a mean size of 3.6 ± 1.3 cm2. The mean follow-up time was 25.7 months. Visual analog scale (VAS), Lysholm knee score, and Tegner activity scale were the instruments used to evaluate the clinical status. Magnetic resonance observation of cartilage repair tissue (MOCART) system was used to analyze the characteristics of repair tissue.


RESULTS
Better VAS and Lysholm scores were detected in group 1 at 12 and 24 months (P = .019 and P = .025). According to the Tegner activity scale, group 1 had also better activity level at the end of 24 months after surgery (P = .020). The mean time from surgery to return to nonimpact sports activities was 7.8 months in group 1, whereas it was 9.2 months in group 2 (P = .013). Complete repair with the filling of the defect was achieved in 7 (36.8%) of the knees in group 1, whereas it was 4 (16.6%) of the knees in group 2 according to the MOCART system at 24 months.


CONCLUSIONS
Single-stage regenerative cartilage surgery using hyaluronic acid-based cell-free scaffold in combination with microfracture for focal osteochondral lesions of the knee revealed promising clinical outcomes at 24 months of follow-up, but the clinical significance of the differences seen is simply not known.


METHODS
Level III, retrospective comparative study.
Department of Orthopedics, Erzincan University Faculty of Medicine, Erzincan, Turkey. Electronic address: hakansofu@yahoo.com.
Hakan
H
Sofu
Department of Orthopedics, Erzincan University Faculty of Medicine, Erzincan, Turkey.
Nizamettin
N
Kockara
Erzincan Mengucekgazi Education and Research Hospital, Erzincan, Turkey.
Ali
A
Oner
Department of Orthopedics, Erzincan University Faculty of Medicine, Erzincan, Turkey.
Yalkin
Y
Camurcu
Department of Orthopedics, Erzincan University Faculty of Medicine, Erzincan, Turkey.
Ahmet
A
Issın
Department of Orthopedics, Erzincan University Faculty of Medicine, Erzincan, Turkey.
Vedat
V
Sahin
D000293:Adolescent; D000328:Adult; D000368:Aged; D002358:Cartilage, Articular / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006820:Hyaluronic Acid; D007718:Knee Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000534:rehabilitation / Q000601:surgery*; D065466:Lysholm Knee Score; D008297:Male; D008875:Middle Aged; D010008:Osteochondritis Dissecans / Q000150:complications / Q000000981:diagnostic imaging / Q000534:rehabilitation / Q000601:surgery*; D010147:Pain Measurement; D012189:Retrospective Studies; D054457:Tissue Scaffolds; D016896:Treatment Outcome; D055815:Young Adult
D006820:Hyaluronic Acid