L. Andriolo (Bologna, IT)
Rizzoli Orthopaedic Institute, Bologna, Italy II Clinic - Biomechanics LaboratoryPresenter Of 4 Presentations
9.2.3 - Use of ChondroFiller® in Knee Joint: Challenging Cases
18.1.1 - No Sex Influence on Cartilage Surgery Outcome: Analysis at Long-Term Follow-Up
Abstract
Purpose
Studies on knee cartilage lesions generally report controversial results comparing findings of men and women treated with regenerative procedures, although they are based on small patients’ number and short-term follow-ups. The aim of this study was to evaluate differences between sexes in long-term outcomes in patients affected by knee cartilage lesions treated with matrix-assisted autologous chondrocyte transplantation (MACT) technique.
Methods and Materials
A total of 217 patients (155 males and 62 females) were evaluated with the International Knee Documentation Committee (IKDC) subjective score at a minimum 10-year follow up after treatment with MACT for knee chondral lesions. The standardization of the IKDC scores was performed according to the mean score typical for the corresponding age/sex category in a healthy population. A further analysis was performed on a subgroup to compare more homogeneous patients.
Results
The mean follow-up was 14.0 ± 3.4 years (range 10-22 years). Women reported a statistically significant lower IKDC score than men (64.0 ± 23.3 vs 76.1 ± 20.5, respectively) (p<0.0005). The subgroup analysis did not confirm this difference (63.2 ± 23.2 vs 71.7 ± 22.0, respectively) (p>0.05). Finally, the score standardization confirmed the lack of differences between sexes in the total population (-1.8 ± 1.6 vs -1.5 ± 2.0, respectively) (p>0.05) as well as in the homogeneous group analysis (-1.9 ± 1.6 vs -1.7 ± 2.0, respectively) (p>0.05).
Conclusion
This analysis on patients with knee chondral lesions treated with MACT confirmed that women’s outcome was lower than men in the general population at long-term follow-up. However, when homogeneous populations were considered, also with standardized scores based on gender and sex, no differences between sexes were observed.
18.2.9 - Patellofemoral Cartilage Lesions Treated with a Hyaluronan-Based MACT Technique: Results at >15 Years’ Follow-up
Abstract
Purpose
Cartilage lesions of the patellofemoral joint are a challenging condition for orthopedic surgeons. Hyaluronan-based matrix assisted autologous chondrocyte transplantation (MACT) seems to offer significant improvement in the short and mid-term follow-up. The aim of this prospective study was to analyze the long-term results of MACT technique to address patellofemoral cartilage lesions.
Methods and Materials
A total of 38 patients (23 men, 15 women) with full-thickness patellofemoral chondral lesions were treated with a hyaluronan-based MACT and followed prospectively for a minimum follow-up of 15 years (mean 17.8±1.7 years). Twenty-four lesions were located on patella, 10 on trochlea, and 4 patients had both patellar and trochlear defects. Results were evaluated using International Knee Documentation Committee (IKDC) subjective, EuroQol visual analogue scale (EQ-VAS) and Tegner scores.
Results
A statistically significant improvement in all scores was observed up to the final follow-up compared to the preoperative level. The IKDC subjective score improved from 35.3±12.8 at baseline to 75.5±18.9 at 5 years (P<0.0005), then remained stable at 10 years (77.7±19.8), while decreased (not significant) at the final follow-up (68.6±22.6). The mean of EQ-VAS score increased from 54.2±18.1 to 82,6±12.1 (P<0.0009) at 5 years and then remained stable up to 15 years (82.9±14) (P<0.0005). Finally, the sport activity level evaluated with the Tegner score improved significantly from the preoperative score of 1.8±1.1 to the final evaluation score of 3.5±1.7, even if it remained lower with respect to activity level before onset of symptoms (6.4±1.8). Trochlear lesions showed better results compared with patellar lesions (IKDC at 15 years: 80.2±22.9 vs 61.8±21.7, respectively). Three failures were reported: 2 patients required a total knee arthroplasty, and one patient received a scaffold-procedure).
Conclusion
Hyaluronan-based MACT showed positive clinical results and a low failure rate in patients with patellofemoral cartilage lesions up to long-term follow-up. Better results were observed in patients with isolated throclear lesions.
P059 - Treatment of Patellar Cartilage Lesion with a Chitosan-based Scaffold: Clinical and MRI Results at Minimum 2 years of Follow-up
Abstract
Purpose
New cartilage regeneration techniques based on scaffolds have been recently developed to improve the results of microfracture treatment, also in complex locations like the patello-femoral joint. The aim of this study was to analyze the clinical and MRI results obtained exclusively in patellar lesions treated with a bioscaffold, a solution composed by chitosan and glycerophosphate which forms a stable clot into the lesion.
Methods and Materials
In this study,15 patients with ICRS grade 3 and 4 cartilage lesions of the patellar surface were enrolled and treated with chitosan bioscaffold. The mean age of patients was 31.8 ± 11.9 and nine patients presented degenerative etiology, while four patients had previous trauma and one patient was affected by patellar osteochondritis dissecans. The mean area of patellar chondral lesion was 2.90 ± 0.97 cm2. Patients were clinically evaluated up to 24 months with IKDC, KOOS and Tegner scores and they underwent MRI evaluation at 24 months.
Results
A statistically significant improvement was reported for the clinical score analyzed. The IKDC subjective score improved from 46.2 ± 19.3 preoperatively to 69.5± 20.3 (p<0.05) and 74.1 ± 23.2 (p<0.05) at 12 and 24 months, respectively. A similar trend was found for KOOS Pain, KOOS Sport/Rec, KOOS QOL, showing a significant improvement from baseline to 12 months and to the final follow-up. Finally, the total MOCART 2.0 score at 24 months after surgery was 71.5 ± 13.6.
Conclusion
Chondral patellar lesions represent a complex pathology, with lower results compared to other sites, probably related to the biomechanical and biological complexity of the patellofemoral joint. The results of the present study showed that this scaffold represents a safe surgical treatment providing a significant clinical improvement in the treatment of patellar cartilage lesions at 24 months also confirmed by promising MRI results.
Meeting Participant Of
Presenter Of 3 Presentations
P059 - Treatment of Patellar Cartilage Lesion with a Chitosan-based Scaffold: Clinical and MRI Results at Minimum 2 years of Follow-up
Abstract
Purpose
New cartilage regeneration techniques based on scaffolds have been recently developed to improve the results of microfracture treatment, also in complex locations like the patello-femoral joint. The aim of this study was to analyze the clinical and MRI results obtained exclusively in patellar lesions treated with a bioscaffold, a solution composed by chitosan and glycerophosphate which forms a stable clot into the lesion.
Methods and Materials
In this study,15 patients with ICRS grade 3 and 4 cartilage lesions of the patellar surface were enrolled and treated with chitosan bioscaffold. The mean age of patients was 31.8 ± 11.9 and nine patients presented degenerative etiology, while four patients had previous trauma and one patient was affected by patellar osteochondritis dissecans. The mean area of patellar chondral lesion was 2.90 ± 0.97 cm2. Patients were clinically evaluated up to 24 months with IKDC, KOOS and Tegner scores and they underwent MRI evaluation at 24 months.
Results
A statistically significant improvement was reported for the clinical score analyzed. The IKDC subjective score improved from 46.2 ± 19.3 preoperatively to 69.5± 20.3 (p<0.05) and 74.1 ± 23.2 (p<0.05) at 12 and 24 months, respectively. A similar trend was found for KOOS Pain, KOOS Sport/Rec, KOOS QOL, showing a significant improvement from baseline to 12 months and to the final follow-up. Finally, the total MOCART 2.0 score at 24 months after surgery was 71.5 ± 13.6.
Conclusion
Chondral patellar lesions represent a complex pathology, with lower results compared to other sites, probably related to the biomechanical and biological complexity of the patellofemoral joint. The results of the present study showed that this scaffold represents a safe surgical treatment providing a significant clinical improvement in the treatment of patellar cartilage lesions at 24 months also confirmed by promising MRI results.