title: One-Step Treatment for Patellar Cartilage Defects With a Cell-Free Osteochondral Scaffold: A Prospective Clinical and MRI Evaluation.
abstract: BACKGROUND
  The treatment of symptomatic cartilage defects of the patella is particularly challenging, and no gold standard is currently available.
  
  
  OBJECTIVE
  To evaluate the clinical results of a biphasic cell-free collagen-hydroxyapatite scaffold and to evaluate osteochondral tissue regeneration with magnetic resonance imaging (MRI).
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  Thirty-four patients (18 men and 16 women; mean ± SD: age, 30.0 ± 10 years) were treated by scaffold implantation for knee chondral or osteochondral lesions of the patella (area, 2.1 ± 1 cm2). The clinical evaluation was performed prospectively at 12 and 24 months via the IKDC (International Knee Documentation Committee; objective and subjective) and Tegner scores. MRI evaluation was performed at both follow-ups in 18 lesions through the MOCART score (magnetic resonance observation of cartilage repair tissue) and specific subchondral bone parameters.
  
  
  RESULTS
  A statistically significant improvement in all the scores was observed at 12- and 24-month follow-up as compared with the basal evaluation. The IKDC subjective score improved from 39.5 ± 14.5 to 61.9 ± 14.5 at 12 months ( P > .0005) with a further increase to 67.6 ± 17.4 at 24 months of follow-up (12-24 months, P = .020). The MRI evaluation showed a stable value of the MOCART score between 12 and 24 months, with a complete filling of the cartilage in 87.0% of the lesions, complete integration of the graft in 95.7%, and intact repair tissue surface in 69.6% at final follow-up. The presence of osteophytes or more extensive bony overgrowth was documented in 47.8% of the patients of this series, but no correlation was found between MRI findings and clinical outcome.
  
  
  CONCLUSIONS
  The implantation of a cell-free collagen-hydroxyapatite osteochondral scaffold provided a clinical improvement at short-term follow-up for the treatment of patellar cartilage defects. Women had lower outcomes, and the need for realignment procedures led to a slower recovery. MRI evaluation showed some abnormal findings with the presence of bone overgrowth, but no correlation has been found with the clinical outcome.
authors.affiliation: I Orthopaedic and Traumatologic Clinic-University of Bologna, Rizzoli Orthopaedic Institute, Bologna, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Perdisa
authors.affiliation: Nano-biotechnology Laboratory, Rizzoli Orthopaedic Institute, Bologna, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Filardo
authors.affiliation: I Orthopaedic and Traumatologic Clinic-University of Bologna, Rizzoli Orthopaedic Institute, Bologna, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Sessa
authors.affiliation: Radiology Department, Rizzoli Orthopaedic Institute, Bologna, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Busacca
authors.affiliation: Sicily Department, Rizzoli Orthopaedic Institute, Bagheria, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Zaffagnini
authors.affiliation: I Orthopaedic and Traumatologic Clinic-University of Bologna, Rizzoli Orthopaedic Institute, Bologna, Italy.
authors.forename: Maurilio
authors.initials: M
authors.lastname: Marcacci
authors.affiliation: I Orthopaedic and Traumatologic Clinic-University of Bologna, Rizzoli Orthopaedic Institute, Bologna, Italy.|Nano-biotechnology Laboratory, Rizzoli Orthopaedic Institute, Bologna, Italy.
authors.forename: Elizaveta
authors.initials: E
authors.lastname: Kon
mesh_terms: D000328:Adult; D002357:Cartilage Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D002358:Cartilage, Articular / Q000000981:diagnostic imaging / Q000293:injuries*; D003094:Collagen / Q000008:administration & dosage; D017886:Durapatite / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D048091:Guided Tissue Regeneration / Q000379:methods*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010329:Patella / Q000000981:diagnostic imaging; D011446:Prospective Studies; D054457:Tissue Scaffolds; D014945:Wound Healing
chemical_list: D003094:Collagen; D017886:Durapatite
keywords: MRI; cartilage regeneration; knee; osteochondral scaffold; patella