Multiple and single articular cartilage lesion treatment with multi-layer MaioRegen chondroplus scaffolds and bone marrow stimulation

Abstract

Introduction Articular cartilage (AC) lesions are among the most difficult to diagnose and treat of all joint disorders. The affected AC usually lacks regeneration and initiates degenerative processes which are difficult to control and lead to osteoarthritis. Most often, in Lithuania these lesions are treated only by microfracture; it is known that only 1-3 % of cells capable of regeneration remain in the joint after this procedure. Recently, the use of multilayer collagen scaffolds together with bone marrow stimulation methods (BMS +S) is becoming increasingly popular. This type of treatment is expensive and not covered by national healthcare insurance in Lithuania, which shows the need of efficiency analysis and indication determination for this treatment. Aims and Objectives Compare BMS +S and bone marrow stimulation (BMS) treatment methods when treating singular and multiple AC lesions. Materials and methods A retrospective study compared BMS+S (35 patients) and BMS (40 patients) methods in treating singular and multiple AC lesions. In total 75 patients were included, operated between 2010 and 2018. Patients who underwent concurrent high tibial osteostomy (HTO), anterior cruciate ligament reconstruction (ACLr) and medial patellofemoral ligament reconstruction (MPFLr) were included in the study. BMS +S method was carried out using MaioRegen chondroplus multi-layer collagen and hydroxyapatite scaffolds secured with fibrin glue. All diagnosed AC lesions were treated in all cases. For final evaluation 8 groups were distinguished by procedure complexity - 1 - BMS+S; 2 - BMS+S+HTO; 3 - BMS+S+ACLr; 4 - BMS+S+MPFLr; 5 - BMS; 6 - BMS+HTO; 7 - BMS+ACLr; 8 - BMS+MPFLr. The results were evaluated using the ICRS questionnaire and in some cases – MRI assessment. Mean time of evaluation in the BMS+S groups - 9.5 months (8- 24 mo.) and 6,8 years (2–8 y) in the BMS groups. In the pre-operative assessment there was no difference between BMS+S and BMS groups, other than patients in the BMS+S group being younger (mean age 38,7 y) and larger defect size (mean 5,8c m2 ) compared to BMS group (mean age 49,5 y; mean lesion size 2,8 cm2 ). Results Significant clinical ICRS score improvements was noted in all groups during the assessment period (p < 0.05). Comparement between BMS+S and BMS groups showed highest ICRS scores when treating single patellar groove (p = 0.001), medial femoral condyle (p = 0.04) and lateral femoral condyle (p = 0.02) AC lesions. Mean BMS+S group's ICRS score after 9,5 months (8– 24 mo) was 87, and the BMS group's 68.7 after 6.8 years (2–8 y) (p = 0.001). […].