BACKGROUND: Bone marrow stimulation techniques in cartilage repair such as drilling are limited by the formation of fibrous to hyaline-like repair tissue. It has been suggested such techniques can be enhanced by covering the defect with scaffolds. We present an innovative approach using a polyglycolic acid (PGA)-hyaluronan scaffold with platelet-rich-plasma (PRP) in drilling. QUESTIONS/PURPOSES: We asked whether (1) PRP immersed in a cell-free PGA-hyaluronan scaffold improves patient-reported 1-year outcomes for the Knee injury and Osteoarthritis Score (KOOS), and (2) implantation of the scaffold in combination with bone marrow stimulation leads to the formation of hyaline-like cartilage repair tissue. PATIENTS AND METHODS: We reviewed 52 patients who had arthroscopic implantation of the PGA-hyaluronan scaffold immersed with PRP in articular cartilage defects of the knee pretreated with Pridie drilling. Patients were assessed by KOOS. At 9 months followup, histologic staining was performed in specimens obtained from five patients to assess the repair tissue quality. RESULTS: The KOOS subscores improved for pain (55 to 91), symptoms (57 to 88), activities of daily living (69 to 86), sports and recreation (36 to 70), and quality of life (38 to 73). The histologic evaluation showed a homogeneous hyaline-like cartilage repair tissue. CONCLUSIONS: The cell-free PGA-hyaluronan scaffold combined with PRP leads to cartilage repair and improved patient-reported outcomes (KOOS) during 12 months of followup. Histologic sections showed morphologic features of hyaline-like repair tissue. Long-term followup is needed to determine if the cartilage repair tissue is durable. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
BACKGROUND: Bone marrow stimulation techniques in cartilage repair such as drilling are limited by the formation of fibrous to hyaline-like repair tissue. It has been suggested such techniques can be enhanced by covering the defect with scaffolds. We present an innovative approach using a polyglycolic acid (PGA)-hyaluronan scaffold with platelet-rich-plasma (PRP) in drilling. QUESTIONS/PURPOSES: We asked whether (1) PRP immersed in a cell-free PGA-hyaluronan scaffold improves patient-reported 1-year outcomes for the Knee injury and Osteoarthritis Score (KOOS), and (2) implantation of the scaffold in combination with bone marrow stimulation leads to the formation of hyaline-like cartilage repair tissue. PATIENTS AND METHODS: We reviewed 52 patients who had arthroscopic implantation of the PGA-hyaluronan scaffold immersed with PRP in articular cartilage defects of the knee pretreated with Pridie drilling. Patients were assessed by KOOS. At 9 months followup, histologic staining was performed in specimens obtained from five patients to assess the repair tissue quality. RESULTS: The KOOS subscores improved for pain (55 to 91), symptoms (57 to 88), activities of daily living (69 to 86), sports and recreation (36 to 70), and quality of life (38 to 73). The histologic evaluation showed a homogeneous hyaline-like cartilage repair tissue. CONCLUSIONS: The cell-free PGA-hyaluronan scaffold combined with PRP leads to cartilage repair and improved patient-reported outcomes (KOOS) during 12 months of followup. Histologic sections showed morphologic features of hyaline-like repair tissue. Long-term followup is needed to determine if the cartilage repair tissue is durable. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Authors: Peter C Kreuz; Christoph Erggelet; Matthias R Steinwachs; Stefanie J Krause; Andreas Lahm; Philipp Niemeyer; Nadir Ghanem; Markus Uhl; Norbert Südkamp Journal: Arthroscopy Date: 2006-11 Impact factor: 4.772
Authors: Daniel B F Saris; Johan Vanlauwe; Jan Victor; Miroslav Haspl; Michael Bohnsack; Yves Fortems; Bruno Vandekerckhove; K Frederik Almqvist; Toon Claes; Frank Handelberg; Koen Lagae; Jan van der Bauwhede; Hilde Vandenneucker; K Gie Auw Yang; Mislav Jelic; Rene Verdonk; Nancy Veulemans; Johan Bellemans; Frank P Luyten Journal: Am J Sports Med Date: 2008-02 Impact factor: 6.202
Authors: Elizaveta Kon; Alberto Gobbi; Giuseppe Filardo; Marco Delcogliano; Stefano Zaffagnini; Maurilio Marcacci Journal: Am J Sports Med Date: 2008-12-04 Impact factor: 6.202
Authors: Katja Pinker; Pavol Szomolanyi; Goetz C Welsch; Tallal C Mamisch; Stefan Marlovits; Andreas Stadlbauer; Siegfried Trattnig Journal: AJR Am J Roentgenol Date: 2008-11 Impact factor: 3.959
Authors: Gunnar Knutsen; Jon Olav Drogset; Lars Engebretsen; Torbjørn Grøntvedt; Vidar Isaksen; Tom C Ludvigsen; Sally Roberts; Eirik Solheim; Torbjørn Strand; Oddmund Johansen Journal: J Bone Joint Surg Am Date: 2007-10 Impact factor: 5.284
Authors: Jan Philipp Krüger; Undine Freymannx; Samuel Vetterlein; Katja Neumann; Michaela Endres; Christian Kaps Journal: Transfus Med Hemother Date: 2013-10-27 Impact factor: 3.747
Authors: Eleftherios A Makris; Andreas H Gomoll; Konstantinos N Malizos; Jerry C Hu; Kyriacos A Athanasiou Journal: Nat Rev Rheumatol Date: 2014-09-23 Impact factor: 20.543
Authors: Heenam Kwon; Lin Sun; Dana M Cairns; Roshni S Rainbow; Rucsanda C Preda; David L Kaplan; Li Zeng Journal: Acta Biomater Date: 2013-01-16 Impact factor: 8.947
Authors: Armin Arshi; Peter D Fabricant; Derek E Go; Riley J Williams; David R McAllister; Kristofer J Jones Journal: Cartilage Date: 2017-12-15 Impact factor: 4.634