TruFit Plugs for Articular Cartilage Repair in the Knee: 2 Year Experience, Results and MRI Appearances (SS-59)

Article Outline

• Introduction
• Methods
• Results
• Conclusions
• Copyright

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Introduction 

To report on early clinical experience with 2 year results of articular cartilage repair in the knee using Synthetic TruFit CB plugs. This techinique is off-label in US but is approved for use in UK, where this study took place.

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Methods 

26 Patients have undergone cartilage repair in the knee using TruFit Plugs (Smith and Nephew UK), a biphasic absorbable scaffold designed to capture mmarrow elements and encourage differentiation into articular cartilage and into bone. All patients have been prospecitively analysed collecting demographic, operative, clinical and MRI radiological outcome assessment. Data was collected at 12, 18 and 24 months post implantation. Protected weight bearing was advised for 4 weeks and sport avoided for 3 months.

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Results 

Of the 26 patients, 22 are male and 4 female with mean age 34.5 years (range 19-49). Repair was performed for lesions less than 2 cm diameter on the medial femoral condyle in 15, the lateral femoral condyle in 4, and the trochlea in 7. In 13 the cause was sport related, 2 had osteochondral defects and the remainder had gradual onset of symptoms. The number of plug used ranged from 1 to 4 per patient. All patients have improved and there have been no infective or thromboembolic complications. At 12 months the mean Tegner activity score improved from 2.4 to 6 (p =0.009). The mean Lysholm score improved from 48.3 to 71 (p = 0.008) and IKDC subjective scores improved from a mean of 37.7 to 65.1 (p = 0.004). KOOS outcome data showed statistically significant improvement in all domains with the mean KOOS sport and recreation score improving an average of 46 points (p<0.001). Within the SF-36 Health Outcome measures, the physical component score (PCS) improved from 39.5 to 50.3 (p = 0.018), and the mental component score (MCS) showed no significant differences, changing from 52.1 to 51.3 (p = 0.37). At 24 months all paramaters show a trend for further improvement but not statistically significant. Two patients underwent second look arthroscopy because they still had pain at more than 6 months post surgery. Arthroscopy in the first patient, performed for medial pain, showed a well integrated and firm repaired area, consistent with MRI appearances. Pain has subsequently settled. Arthroscopy in the second patient showed the repaired area to have filled in but the surface was very soft. Effusion and pain were slow to settle. The graft (3 plugs) remained in position and by 18 months he has become pain free and is playing impact sport. MRI imaging on this series has shown reformation of the subchondral lamina and T2 Mapping has shown tissue values similar to normal surronding cartilage by 9 months.

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Conclusions 

We believe that TruFit plugs offer an attractive solution to the management of full thickness chondral injuries enabling rapid mobilisation and return to sport. TruFit plugs provide a stable scaffold for early mobilisation of the knee post operatively, avoiding the prolonged period of limited weight bearing as follows microfracture, and the long recovery time following ACI. We believe that TruFit plugs appear to provide a simple one step solution in the management of small areas of chondral injury (<2cm diameter), particularly in patients who require rapid rehabilitation, and are keen to remain active at a high level.