Different techniques have been proposed across the years to treat osteochondral diseases: minimally invasive bone marrow stimulation techniques aimed at favoring the healing process in the injured area through the migration of stem cells from the subchondral bone; on the other side, some more aggressive techniques are based on autologous or allogenic tissue transplant. Unfortunately, both the high specialization and the low healing potential of the cartilage tissue still make the treatment of cartilage defects a challenge for the orthopedic surgeon. Bioengineered scaffolds or polymeric matrices implanted in the injured area showed promising results. The range of scaffolds in use for chondral or osteochondral repair is very wide; they differ not only with respect to the type of the materials used for their realization but also for the presence or absence of one or more cell lines - either chondrogenic or osteogenic. When approaching big chondral lesions, the subchondral bone is often involved and it also needs to be treated in order to have a correct restoration of the most superficial layers of the joint. In our opinion the smartest treatment choice could be a cell-free osteochondral scaffold, an off-the-shelf product, thus immediately available, avoiding the double surgical time. Following this rationale, after preclinical in vitro and animal studies and under the approval of the local ethics committee, we introduced the use of a newly developed nanostructured biomimetic scaffold in a clinical pilot study to treat chondral and osteochondral lesions of the knee. Its safety and manageability, as much as the surgical procedure reproducibility and the clinical outcome, have been evaluated up to 36 months' follow-up in order to test its intrinsic potential without any cells culture aid.
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