J Knee Surg 2022; 35(02): 222-230
DOI: 10.1055/s-0041-1729550
Original Article

Comparison of All Arthroscopic Implantation of Chitosan-Based Liquid Scaffold and Hyaluronan-Based Soft Scaffold in the Treatment of Condylar Osteochondral Lesions in the Knee

Ramazan Akmeşe
1   Department of Orthopedics and Traumatology, Ankara University, Ankara, Turkey
,
Emre Anıl Özbek
1   Department of Orthopedics and Traumatology, Ankara University, Ankara, Turkey
,
Hakan Kocaoğlu
1   Department of Orthopedics and Traumatology, Ankara University, Ankara, Turkey
,
1   Department of Orthopedics and Traumatology, Ankara University, Ankara, Turkey
,
İrem İnanç
2   Department of Histology and Embryology, Ankara University, Ankara, Turkey
,
Esra Erdemli
2   Department of Histology and Embryology, Ankara University, Ankara, Turkey
› Author Affiliations
Funding None.

Abstract

Cell-free scaffolds used in cartilage regeneration are produced from different materials. The aim of this study is to compare the clinical and radiological results of two different scaffolds with hyaluronan- or chitosan-based structure used in the treatment of symptomatic condylar osteochondral lesions. The study comprises 69 patients who were operated for osteochondral lesion repair with hyaluronan- (n = 37) or chitosan-based (n = 32) scaffold. The International Knee Documentation Committee (IKDC), Lysholm Knee Scoring Scale and Visual Analog Scale (VAS) scores were collected for both groups at the preoperative and postoperative 3rd, 12th, and 24th months. Magnetic resonance imaging was performed between the 12th and 15th months postoperatively and this with magnetic resonance observation of cartilage repair tissue (MOCART) scoring were compared. Within group assessments demonstrate significant improvement in IKDC, Lysholm, and VAS scores at postoperative 3rd and 12th months. However, in both groups, IKDC, Lysholm and, VAS scores at the postoperative 24th month indicate no significant further improvement, compared with the 12th month results. There was no significant difference between the groups in terms of IKDC, Lysholm, VAS, and MOCART scores at any time period. This study shows that both scaffolds are useful in cartilage regeneration but have no clinical or radiological superiority to each other. Surgeons should select the method with which they feel comfortable. This is a level III, retrospective comparative study.



Publication History

Received: 06 December 2020

Accepted: 12 March 2021

Article published online:
30 April 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Curl WW, Krome J, Gordon ES, Rushing J, Smith BP, Poehling GG. Cartilage injuries: a review of 31,516 knee arthroscopies. Arthroscopy 1997; 13 (04) 456-460
  • 2 Hjelle K, Solheim E, Strand T, Muri R, Brittberg M. Articular cartilage defects in 1,000 knee arthroscopies. Arthroscopy 2002; 18 (07) 730-734
  • 3 Bhosale AM, Richardson JB. Articular cartilage: structure, injuries and review of management. Br Med Bull 2008; 87 (01) 77-95
  • 4 Jakobsen RB, Engebretsen L, Slauterbeck JR. An analysis of the quality of cartilage repair studies. J Bone Joint Surg Am 2005; 87 (10) 2232-2239
  • 5 Benthien JP, Schwaninger M, Behrens P. We do not have evidence based methods for the treatment of cartilage defects in the knee. Knee Surg Sports Traumatol Arthrosc 2011; 19 (04) 543-552
  • 6 Mithoefer K, McAdams T, Williams RJ, Kreuz PC, Mandelbaum BR. Clinical efficacy of the microfracture technique for articular cartilage repair in the knee: an evidence-based systematic analysis. Am J Sports Med 2009; 37 (10) 2053-2063
  • 7 Hoemann CD, Hurtig M, Rossomacha E. et al. Chitosan-glycerol phosphate/blood implants improve hyaline cartilage repair in ovine microfracture defects. J Bone Joint Surg Am 2005; 87 (12) 2671-2686
  • 8 Gobbi A, Nunag P, Malinowski K. Treatment of full thickness chondral lesions of the knee with microfracture in a group of athletes. Knee Surg Sports Traumatol Arthrosc 2005; 13 (03) 213-221
  • 9 Fortier LA, Potter HG, Rickey EJ. et al. Concentrated bone marrow aspirate improves full-thickness cartilage repair compared with microfracture in the equine model. J Bone Joint Surg Am 2010; 92 (10) 1927-1937
  • 10 Frisbie DD, Oxford JT, Southwood L. et al. Early events in cartilage repair after subchondral bone microfracture. Clin Orthop Relat Res 2003; 407 (407) 215-227
  • 11 Chevrier A, Hoemann CD, Sun J, Buschmann MD. Chitosan-glycerol phosphate/blood implants increase cell recruitment, transient vascularization and subchondral bone remodeling in drilled cartilage defects. Osteoarthritis Cartilage 2007; 15 (03) 316-327
  • 12 Kon E, Filardo G, Di Matteo B, Perdisa F, Marcacci M. Matrix assisted autologous chondrocyte transplantation for cartilage treatment: A systematic review. Bone Joint Res 2013; 2 (02) 18-25
  • 13 Hegewald AA, Ringe J, Bartel J. et al. Hyaluronic acid and autologous synovial fluid induce chondrogenic differentiation of equine mesenchymal stem cells: a preliminary study. Tissue Cell 2004; 36 (06) 431-438
  • 14 Zelle S, Zantop T, Schanz S, Petersen W. Arthroscopic techniques for the fixation of a three-dimensional scaffold for autologous chondrocyte transplantation: structural properties in an in vitro model. Arthroscopy 2007; 23 (10) 1073-1078
  • 15 Shigemasa Y, Minami S. Applications of chitin and chitosan for biomaterials. Biotechnol Genet Eng Rev 1996; 13 (01) 383-420
  • 16 Kumar MNVR, Muzzarelli RAA, Muzzarelli C, Sashiwa H, Domb AJ. Chitosan chemistry and pharmaceutical perspectives. Chem Rev 2004; 104 (12) 6017-6084
  • 17 Hoemann CD, Sun J, McKee MD. et al. Chitosan-glycerol phosphate/blood implants elicit hyaline cartilage repair integrated with porous subchondral bone in microdrilled rabbit defects. Osteoarthritis Cartilage 2007; 15 (01) 78-89
  • 18 Whyte GP, Gobbi A, Sadlik B. Dry arthroscopic single-stage cartilage repair of the knee using a hyaluronic acid-based scaffold with activated bone marrow-derived mesenchymal stem cells. Arthrosc Tech 2016; 5 (04) e913-e918
  • 19 Stanish WD, McCormack R, Forriol F. et al. Novel scaffold-based BST-CarGel treatment results in superior cartilage repair compared with microfracture in a randomized controlled trial. J Bone Joint Surg Am 2013; 95 (18) 1640-1650
  • 20 Sofu H, Kockara N, Oner A, Camurcu Y, Issın A, Sahin V. Results of hyaluronic acid-based cell-free scaffold application in combination with microfracture for the treatment of osteochondral lesions of the knee: 2-year comparative study. Arthroscopy 2017; 33 (01) 209-216
  • 21 Shive MS, Stanish WD, McCormack R. et al. BST-CarGel® Treatment Maintains Cartilage Repair Superiority over Microfracture at 5 Years in a Multicenter Randomized Controlled Trial. Cartilage 2015; 6 (02) 62-72
  • 22 Gobbi A, Whyte GP. One-stage cartilage repair using a hyaluronic acid-based scaffold with activated bone marrow-derived mesenchymal stem cells compared with microfracture: five-year follow-up. Am J Sports Med 2016; 44 (11) 2846-2854
  • 23 Rothrauff BB, Murawski CD, Angthong C. et al; International Consensus Group on Cartilage Repair of the Ankle. Scaffold-based therapies: proceedings of the international consensus meeting on cartilage repair of the ankle. Foot Ankle Int 2018; 39 (1_suppl, suppl): 41S-47S
  • 24 Welsch GH, Mamisch TC, Quirbach S, Zak L, Marlovits S, Trattnig S. Evaluation and comparison of cartilage repair tissue of the patella and medial femoral condyle by using morphological MRI and biochemical zonal T2 mapping. Eur Radiol 2009; 19 (05) 1253-1262
  • 25 Buda R, Vannini F, Cavallo M, Grigolo B, Cenacchi A, Giannini S. Osteochondral lesions of the knee: a new one-step repair technique with bone-marrow-derived cells. J Bone Joint Surg Am 2010; 92 (02, Suppl 2): 2-11
  • 26 Gobbi A, Scotti C, Karnatzikos G, Mudhigere A, Castro M, Peretti GM. One-step surgery with multipotent stem cells and Hyaluronan-based scaffold for the treatment of full-thickness chondral defects of the knee in patients older than 45 years. Knee Surg Sports Traumatol Arthrosc 2017; 25 (08) 2494-2501
  • 27 Siclari A, Mascaro G, Gentili C, Cancedda R, Boux E. A cell-free scaffold-based cartilage repair provides improved function hyaline-like repair at one year. Clin Orthop Relat Res 2012; 470 (03) 910-919
  • 28 da Cunha CB, Andrade R, Veloso TR, Learmonth DA, Espregueira-Mendes J, Sousa RA. Enhanced microfracture using acellular scaffolds improves results after treatment of symptomatic focal grade III/IV knee cartilage lesions but current clinical evidence does not allow unequivocal recommendation. Knee Surg Sports Traumatol Arthrosc 2020; 28 (10) 3245-3257
  • 29 Giannini S, Buda R, Battaglia M. et al. One-step repair in talar osteochondral lesions: 4-year clinical results and t2-mapping capability in outcome prediction. Am J Sports Med 2013; 41 (03) 511-518
  • 30 Kreuz PC, Steinwachs MR, Erggelet C. et al. Results after microfracture of full-thickness chondral defects in different compartments in the knee. Osteoarthritis Cartilage 2006; 14 (11) 1119-1125