A Pilot Study of the Use of an Osteochondral Scaffold Plug for Cartilage Repair in the Knee and How to Deal With Early Clinical Failures

Dhollander, Aad A.M.; Liekens, Koen; Almqvist, Karl F.; Verdonk, René; Lambrecht, Stijn; Elewaut, Dirk; Verbruggen, Gust; Verdonk, Peter C.M.

doi:10.1016/j.arthro.2011.07.017

« Previous Next »Arthroscopy: The Journal of Arthroscopic and Related Surgery
Volume 28, Issue 2 , Pages 225-233, February 2012

A Pilot Study of the Use of an Osteochondral Scaffold Plug for Cartilage Repair in the Knee and How to Deal With Early Clinical Failures

Aad A.M. Dhollander, M.D.
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
- Laboratory of Connective Tissue Biology, Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
- Address correspondence to Aad A.M. Dhollander, M.D., Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185 (P5), 9000 Ghent, Belgium
Koen Liekens, M.D.
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
Karl F. Almqvist, M.D., Ph.D.
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
René Verdonk, M.D., Ph.D.
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
Stijn Lambrecht, Ph.D.
- Laboratory of Connective Tissue Biology, Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
Dirk Elewaut, M.D., Ph.D.
- Laboratory of Connective Tissue Biology, Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
Gust Verbruggen, M.D., Ph.D.
- Laboratory of Connective Tissue Biology, Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
Peter C.M. Verdonk, M.D., Ph.D.
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
- Department of Orthopaedic Surgery and Traumatology, Stedelijk Ziekenhuis Roeselare, Roeselare, Belgium

Received 12 January 2011; accepted 27 July 2011. published online 21 October 2011.

Purpose

To present our short-term experience with an osteochondral scaffold plug (TruFit plug; Smith & Nephew, Andover, MA) for cartilage repair in the knee and, more importantly, to discuss our approach to treat early clinical failures.

Methods

Twenty patients were consecutively treated for their cartilage lesions with the plug technique. These patients were prospectively clinically evaluated at 6 and 12 months of follow-up. Magnetic resonance imaging (MRI) was used for morphologic analysis of the cartilage repair. Biopsy samples were taken from 3 cases during revision surgery, allowing histologic assessment of the repair tissue.

Results

The short-term clinical and MRI outcome of this pilot study are modest. No signs of deterioration of the repair tissue were observed. Of the 15 patients followed up during 1 year, 3 (20.0%) showed persistent clinical symptoms or even more clinical symptoms after insertion of the plug. These patients were considered as failures and therefore eligible for revision surgery. During revision surgery, the repair tissue was carefully removed. The remaining osteochondral defect was filled with autologous bone grafts. Immediate and persistent relief of symptoms was observed in all 3 patients. Histologic assessment of biopsy specimens taken during revision surgery showed fibrous vascularized repair tissue with the presence of foreign-body giant cells.

Conclusions

The overall short-term clinical and MRI outcome of the osteochondral scaffold plug for cartilage repair in the knee is modest. In this pilot study a modest clinical improvement became apparent at 12 months of follow-up. MRI data showed no deterioration of the repair tissue. Of the 15 patients, 3 (20%) had persistent clinical symptoms after surgery. These patients were successfully treated with removal of the osteochondral plug remnants and the application of autologous bone grafts.