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Abstract Presented at the 26th Annual Meeting of the Arthroscopy Association of North America| Volume 23, ISSUE 6, SUPPLEMENT , e22-e23, June 2007

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Prospective Evaluation of Osteochondral Defects in the Knee Treated with Biodegradable Scaffolds (SS-45)

      Summary

      Symptomatic full thickness chondral and osteochondral defects of the knee present a considerable treatment challenge. This study investigates the use of a biodegradable polymeric scaffold for articular cartilage repair. 26 cases were implanted over 1 year with an orthobiologic scaffold to replace tissue removed in the treatment of chondral and osteochondral defects. Mean area grafted was 1.7 cm2 (range 0.6-5.7 cm2). SF-36, IKDC and Lysholm scores improved significantly when compared to preoperative status. This technology shows significant promise in the clinical treatment of relatively small chondral and osteochondral defects.

      Purpose

      Symptomatic full thickness chondral and osteochondral defects of the knee present a considerable treatment challenge. This study investigates the use of a biodegradable polymeric scaffold, to fill a bone void, yielding bone and articular cartilage repair and resurfacing.

      Methods

      Sequential patients were enrolled prospectively, following IRB approval of the study. Once a full thickness chondral or osteochondral defect was identified arthroscopically, one or more polymeric orthobiologic scaffolds, cylindrical in shape, were implanted to restore a smooth surface contour. All patients underwent preoperative and postoperative clinical and radiographic evaluation and were examined at regular intervals, systematically collecting quantified clinical outcome scores. Postoperatively all patients were maintained touch down weight bearing with axillary crutches for 6 weeks with immediate full range of motion.

      Results

      26 cases were implanted over 1 year with an orthobiologic scaffold to replace tissue removed in the treatment of chondral and osteochondral defects. Mean follow up was 22 months (range 16 to 32 months). Mean age was 41 years. Mean number of grafts was 1.8 (range 1-7). Mean area grafted was 1.7 cm2 (range 0.6-5.7 cm2). SF-36 Physical mean score improved from 35 pre-treatment to 47 post-surgery. On the SF-36 Mental, mean scores improved from 48 to 55. IKDC mean score improved from 29 to 62. The Lysholm mean score improved from 37 to 67. There was no radiographic evidence of bone lysis or evident complications. One patient was deemed a failure, and went on to arthroplasty for what was felt to be concurrent, unrelated pathologies. There were no other failures, and no complications related to the scaffolds identified.

      Conclusions

      All patients, except one, showed significant improvements post-treatment as measured by each of the scoring instruments. The use of this orthobiologic scaffold potentially eliminates the need for secondary procedures or interventions (such as autologous tissue harvesting or secondary chondrocyte implantation) resulting in decreased patient pain and donor site morbidity. This technology shows significant promise in the clinical treatment of relatively small chondral and osteochondral defects.