Abstract
The purpose of this study was to investigate the clinical results at five years’ follow-up of a tri-layered nanostructured biomimetic osteochondral scaffold used for focal articular cartilage defects in patients meeting the criteria of early osteoarthritis (EOA). The study population comprised 22 patients (mean age: 39 years), prospectively assessed before surgery, at 24 and 60 months’ follow-up. Inclusion criteria were: at least two episodes of knee pain for more than 10 days in the last year, Kellgren-Lawrence OA grade 0, I or II and arthroscopic or MRI findings according to the European Society of Sports Traumatology, Knee Surgery & Arthroscopy (ESSKA) criteria. Clinical results demonstrated significant improvement in International Knee Documentation Committee (IKDC) subjective and objective scores and in Tegner score, although activity level never reached the pre-injury level. The complication rate of this study was 8.3%. Two patients underwent re-operation (8.3%), while a comprehensive definition of failure (including both surgical and clinical criteria) identified four failed patients (16.6%) at this mid-term follow-up evaluation. The use of a free-cell osteochondral scaffold represented a safe and valid alternative for the treatment of focal articular cartilage defects in the setting of an EOA, and was able to permit a significant clinical improvement and stable outcome with low complication and failure rates.
Highlights
Osteoarthritis (OA) is a widespread orthopaedic disease [1] that is typically triggered by aging, and it has a chronic development that eventually leads to pain and functional limitation of the affected joint
The inclusion criterion was that patients have knee articular defects located at the femoral condyles or trochlea, meeting the early OA criteria defined by Luyten et al [2]: (1) at least two episodes of joint pain for more than 10 days in the last year; (2) radiographic Kellgren–Lawrence classification up to grade 2; and (3) arthroscopic findings of cartilage defects
Exclusion criteria were: (1) primary defects located on the tibial plateau or patella, and (2) patients be affected by osteochondritis dissecans (OCD) or uncorrected lower limb axial defects and knee instability
Summary
Osteoarthritis (OA) is a widespread orthopaedic disease [1] that is typically triggered by aging, and it has a chronic development that eventually leads to pain and functional limitation of the affected joint. “Early OA” was first described by Luyten et al [2] as “at least two episodes of joint pain for more than 10 days in the last year, radiographic Kellgren–Lawrence classification up to grade 2, and arthroscopic findings of International Cartilage Regeneration Society (ICRS) cartilage defects grades III or IV with softening and swelling of the surrounding cartilage”. Patients with early OA, often younger than those with advanced OA but still presenting a degenerated knee, represent a challenge for orthopedic surgeons since young age—with its related higher functional requests and long life expectancy—is a major issue for knee replacement. In this light, an increasing interest has recently been given to the distinction of OA in its early phases. Young patients could benefit from new biological or regenerative treatments in order to restore the damaged joint surface, delaying the need for more invasive conventional procedures such as arthroplasty
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