Abstract
The aim of our study was to analyze the clinical outcome after repair of cartilage defects of the knee with subchondral drilling and resorbable polymer-based implants immersed with autologous platelet-rich plasma (PRP). Fifty-two patients with focal chondral defects were treated with subchondral drilling, followed by covering with a polyglycolic acid - hyaluronan (PGA-HA) implant (chondrotissue®) immersed with autologous PRP. At 5-year follow-up, patients’ situation was assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and compared to the pre-operative situation. The KOOS showed clinically meaningful and significant (p < 0.05) improvement in all subcategories compared to baseline. Subgroup analysis showed that there were no differences in the clinical outcome regarding defect size and localization as well as degenerative condition of the knee. Cartilage repair was complete in 20 out of 21 patients at 4-year follow-up as shown by magnetic resonance observation of cartilage repair tissue (MOCART) scoring. Covering of focal cartilage defects with the PGA-HA implant and PRP after bone marrow stimulation leads to a lasting improvement of the patients’ situation.
Highlights
Focal cartilage lesions of the knee are frequently found in symptomatic knees, do not heal spontaneously, are a major health problem and may progress to severe osteoarthritis [1].The most common first-line treatment options for focal cartilage defects are bone marrow stimulating techniques like drilling or microfracturing [2,3,4,5]
In a case series with 52 patients we have shown that implantation of the polyglycolic acidhyaluronan (PGA-HA) implants immersed with autologous platelet-rich plasma (PRP) after subchondral drilling results in significant improvement of the patients’ situation compared to baseline as assessed by the Knee Injury and Osteoarthritis Outcome Score (KOOS) and in the formation of hyaline-like cartilage repair tissue as assessed by histological analysis of repair tissue biopsies, at a one and two year follow-up [24, 25]
The PGA-HA scaffolds were allowed to incubate in 3 mL autologous PRP for 5 to 10 minutes
Summary
The most common first-line treatment options for focal cartilage defects are bone marrow stimulating techniques like drilling or microfracturing [2,3,4,5]. The clinical outcome of bone marrow stimulation is variable and may depend on the size and location of the lesion, the degenerative status of the knee, age, body mass index as well as the activity of the patient. This may lead to uncertain long-term functional improvements [8, 9]. Compared to more advanced cartilage repair procedures like autologous chondrocyte implantation (ACI), the microfracture procedure is technically not demanding, cost effective, a relatively fast to perform one-step procedure and shows good short-term results in patients aged 40-45 and younger [3, 10, 11]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
