Chitosan based scaffold applied in patellar cartilage lesions showed positive clinical and MRI results at minimum 2 years of follow up

Abstract

Purpose New scafold-based cartilage regeneration techniques have been developed to improve the results of microfractures also in complex locations like the patello-femoral joint. The aim of this study was to analyse the results obtained in patellar lesions treated with a bioscafold, a mixture composed by a chitosan solution, a bufer, and the patient's whole blood which forms a stable clot into the lesion. Methods Fifteen patients with ICRS grade 3-4 cartilage lesions of the patellar surface were treated with a chitosan bioscaffold. Fourteen patients were clinically and radiologically evaluated prospectively for a minimum follow-up of 2 years with IKDC, KOOS, Tegner score, and MRI. The mean age of patients at the time of surgery was 31.8 ± 11.9 and nine patients presented degenerative aetiology, four patients with previous trauma, and 1 patient with osteochondritis dissecans. ResultsThe IKDC subjective score improved from 46.2 ± 19.3 preoperatively to 69.5 ± 20.3 (p < 0.05) and 74.1 ± 23.2 (p < 0.05) at 12 and 24 months, respectively. Also KOOS Pain, KOOS Sport/Rec and KOOS QOL showed a signiicant improvement from baseline to 12 months and to the inal follow-up. MRI evaluation showed a complete illing of the cartilage defect at the inal follow-up in 70% of the lesions, obtaining a total MOCART 2.0 score of 71.5 ± 13.6 at 24 months after surgery. Conclusion Chondral patellar lesions represent a complex pathology, with lower results compared to other sites. This bioscafold represents a safe surgical treatment providing a signiicant clinical improvement at 24 months in the treatment of patellar cartilage lesions. Level of evidence IV.

Chitosan‐based scaffold augmentation to microfractures: Stable results at mid‐term follow‐up in patients with patellar cartilage lesions

“…Similarly, MR also showed positive results in terms of tissue repair evaluated through the MOCART 2.0 score. This is an important finding that testifies the persistence of the repair tissue quality at mid‐term follow‐up, which was also compared to values previously documented in the short‐term [ 38 ]. Still, previous studies showed a poor correlation between this score and the patient's symptoms [ 13 , 27 ].…”

“…Scaffolds can be based on different types of matrices, such as collagen [ 3 ], hyaluronic acid [ 50 ] or chitosan, as the scaffold evaluated in the current study [ 38 ]. This chitosan‐based scaffold already showed to provide promising clinical results and improved cartilage repair compared to microfractures for the treatment of condylar cartilage lesions [ 41 , 43 , 47 ].…”

“…This study presents the clinical and imaging assessment at the mid‐term follow‐up of a series of patients affected by patellar cartilage lesions previously evaluated for up to 24 months [ 38 ]. This study was approved by the hospital Ethics Committee of the IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (protocol number 571/2023/Oss/IOR) and informed consent of all patients was obtained.…”

“…The surgical technique involved a one‐stage arthrotomy combining the chitosan‐based scaffold (CARGEL Bioscaffold, formerly BST‐CarGel; Smith & Nephew) with microfractures, as previously reported [ 38 ]. In brief, the patellar cartilage defect was exposed through a medial para‐patellar approach and then prepared to perform the microfracture procedure, according to Steadman et al [ 44 ].…”

“…This scaffold has already been tested in clinical practice, with satisfactory results for the treatment of cartilage lesions localised to the femoral condyles [ 43 , 46 , 47 ]. On the other hand, only a few data are available on the clinical and imaging results of this scaffold for the treatment of challenging patellar cartilage lesions; while promising results have been shown at short‐term follow‐up [ 5 , 38 ], there is still a lack of evidence at mid‐term follow‐up to confirm the durability of the clinical benefit.…”