Cell-free biomimetic scaffold for osteochondral defects: a prospective clinical study at 72 months of follow-up

Objectives: This prospective clinical study tested the mid-term follow- up of a one-step procedure using a cell-free biomimetic multilayered scaffold for the treatment of osteochondral lesions of the knee. Methods: 27 patients (9F, 18 M, mean age 34.9 yy) affected by symptomatic ICRS grade III-IV chondral lesions of the knee were treated. Patients were analyzed prospectively up to 72 months using the ICRS Cartilage Standard Evaluation Form, and high resolution MRI. Sites of the defects were: 7 MFC, 5 LFC, 11 patellae, 7 trochleae, and 2 lateral tibial plateaus. Five patients had multiple lesions. Defect area was 2.9 ± 1.3 cm2. Etiology was traumatic in 5 cases, microtraumatic/degenerative in 16 and OCD in 6 cases. Results: Function recovery and a significant clinical improvement were detected. Mean IKDC subjective increased from 40.0 ± 14.7 to 77.4 ± 19.6 at final evaluation, showing the significant improvement stable over time. Mean pre-injury Tegner score increased from 1.6 ± 1.1 pre-operative to 4.0 ± 1.8 at 12 months and 3.9 ± 1.8 (n.s.) at final follow-up. Despite the significant improvement (p\0.05) at 1 year, the final sport activity was lower than the preinjury level. MRI evaluation revealed a good integration of the scaffold and a satisfactory filling of the defect. Conclusions: This one-step surgery seems to be an easy and effective procedure for chondral and osteochondral lesions of the knee. Results show satisfactory outcomes even in large osteochondral lesions or complex cases. MRI improves over time but abnormal findings are still present at mid-term follow-up.