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Cell-free cartilage repair in large defects of the knee: increased failure rate 5 years after implantation of a collagen type I scaffold

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Cartilage defects of the knee remain a challenging problem in orthopedic surgery despite the ongoing improvements in regenerative procedures such as the autologous chondrocyte transplantation. Due to the lack of donor-site morbidity and the single-stage procedure cell-free scaffolds are an interesting alternative to cell-based procedures. But as currently mid- and long-term data are lacking, the aim of the present study was to present mid-term clinical, radiological and histological results of a cell-free collagen type I scaffolds for cartilage repair.

Materials and methods

Twenty-eight patients were followed prospectively. Clinical evaluation using patient-reported outcome measures (KOOS, IKDC; VAS for pain, Tegner score for activity) as well as radiologic evaluation of the repair tissue (MOCART) was performed at 1 year, 2 years and 5 years. Histologic evaluation of the repair tissue was done in case of revision surgery using the ICRS II score for human cartilage repair.

Results

In these large cartilage defects with a mean defect size of 3.7 ± 1.9 cm2, clinical failure necessitating revision surgery was seen in 5 of 28 patients (18%). While the remaining patients showed good-to-excellent clinical results (KOOS, IKDC, VAS, Tegner), the radiologic appearance of the repair tissue showed a reduction of the MOCART score between the 2- and 5-year follow-up. Histologic evaluation of the repair tissue showed a cartilage-like appearance with no signs of inflammation or cell death but an overall medium tissue quality according to the ICRS II Score.

Conclusion

The use of this cell-free collagen type I scaffold for large defects showed increased wear of the repair tissue and clinical failure in 18% of cases at 5-year follow-up.

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Authors and Affiliations

  1. Centre for Orthopedics and Trauma surgery, University Hospital Marburg, 35043, Marburg, Germany

    Karl-Friedrich Schüttler, A. Götschenberg, A. Klasan, T. J. Heyse & T. Efe

  2. Department of Sporttraumatology, Knee-and Shoulder-Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt, Germany

    T. Stein

  3. Department of Sports Science, University of Bielefeld, Bielefeld, Germany

    T. Stein

  4. Department of Pathology, Philipps-University of Marburg, Marburg, Germany

    A. Pehl

  5. Department of Orthopedics and Traumatology, University Hospital Bonn, Bonn, Germany

    P. P. Roessler

  6. Department of Diagnostic and Interventional Radiology, University Hospital Marburg, Marburg, Germany

    J. Figiel

  7. Orthopeadicum Lich, Gottlieb-Daimler-Str. 7a, 35423, Lich, Germany

    T. Efe

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  1. Karl-Friedrich Schüttler
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  2. A. Götschenberg
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Correspondence to Karl-Friedrich Schüttler.

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Schüttler, KF., Götschenberg, A., Klasan, A. et al. Cell-free cartilage repair in large defects of the knee: increased failure rate 5 years after implantation of a collagen type I scaffold. Arch Orthop Trauma Surg 139, 99–106 (2019). https://doi.org/10.1007/s00402-018-3028-4

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