One step surgery with a biomimetic scaffold to treat osteochondral patellar lesions: prospective study at 2 years of follow-up

Objectives: Aim of this study is to analyze the clinical outcome of an
osteochondral scaffold implanted into chondral and osteohondral
lesions located at the patella, site that is commonly considered as one
of the more difficult to treat successfully.
Methods: Forty-four patients were treated by implanting a collagenhydroxyapatite
osteochondral scaffold and prospectively evaluated at
initial time, then at 6, 12 and 24 months of follow-up, using the IKDC
Knee documentation form and the Kujala score. They were 26 male
and 18 female. Mean age was 33.2 (16–59) years, mean BMI
24.0 ± 3.0. Size of the defects was 3.3 ± 3.0 cm2. Fifteen Patients
were operated for the first time and 23 of them requested combined
procedures due to comorbidities. Four of them had multiple lesions.
Etiology was degenerative in 29 cases, 10 traumatic and 5 were
OCDs.
Results: A statistically significant improvement and function recovery
were recorded up to 24 months. IKDC subj score increased from
39.3 ± 15.1 to 62.6 ± 18.6 and 68.9 ± 17.8 at the 1 year and final
evaluation respectively (p\0.05). Tegner score increased from
1.8 ± 1.1 to 3.6 ± 1.3 at 2 years’ follow-up (p\0.05). Three
patients failed, being re-operated for the same lesion.
Conclusions: The use of this biomimetic cell-free scaffold for
osteochondral lesions of the patella allows to obtain function recovery
and a good clinical outcome at short-term follow-up, even if lower
than previously reported for other site locations. These results have to
be confirmed at longer follow-up to determine the possible benefit of
addressing also the subchondral bone disease.