Patellofemoral full-thickness chondral defects treated with hyalograft-C: A clinical, arthroscopic, and histologic review

Alberto Gobbi, Elisaveta Kon, Massimo Berruto, Ramces Francisco, Giuseppe Filardo, Maurilio Marcacci

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Tissue engineering has emerged as a potential therapeutic option for cartilage regeneration. Hypothesis: Hyaluronan-based scaffolds seeded with autologous chondrocytes are a viable treatment for damaged articular surface of the patellofemoral joint. Study Design: Case series; Level of evidence, 4. Methods: Thirty-two chondral lesions with a mean size of 4.7 cm2 were treated with Hyalograft-C. Twenty-two lesions were located in the patella and 10 in the trochlea. Sixteen patients had previous trauma, 3 had osteochondritis dissecans, and 13 had degenerative changes. Transplantations were carried out arthroscopically or through a miniarthrotomy incision. Eight patients had concomitant procedures, including patellar realignment (2), lateral release (3), and meniscectomy (3). Results were evaluated using the International Cartilage Repair Society-International Knee Documentation Committee scale, EuroQol EQ-5D form, and magnetic resonance imaging scans at 12 and 24 months. Six patients had second-look arthroscopy and biopsies. Statistical analysis was performed using the paired t test and Wilcoxon signed rank test. Results: The International Cartilage Repair Society-International Knee Documentation Committee and EuroQol EQ-5D scores demonstrated a statistically significant improvement (P <.0001). Objective preoperative data improved from 6/32 (18.8%) with International Knee Documentation Committee A or B to 29/32 (90.7%) at 24 months after transplantation. Mean subjective scores improved from 43.2 points preoperatively to 73.6 points 24 months after implantation. Magnetic resonance imaging studies at 24 months revealed 71% to have an almost normal cartilage with positive correlation to clinical outcomes. Second-look arthroscopies in 6 cases revealed the repaired surface to be nearly normal with biopsy samples characterized as hyaline-like in appearance. Conclusion: Biodegradable scaffolds seeded with autologous chondrocytes can be a viable treatment for chondral lesions. The type of tissue repair achieved demonstrated histologic characteristics similar to normal articular cartilage. Long-term investigations are needed to determine the durability of the repair produced with this technique.

Original languageEnglish
Pages (from-to)1763-1773
Number of pages11
JournalAmerican Journal of Sports Medicine
Volume34
Issue number11
DOIs
Publication statusPublished - Nov 2006

Keywords

  • Autologous chondrocyte implantation (ACI)
  • Chondral lesions
  • Chondrocytes
  • Patellofemoral
  • Scaffold

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation

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