Summary

Clinical outcome of a pilot study on a novel and more affordable bovine cartilage scaffold of xenogeneic origin that might provide a promising scaffold alternative to treat full-thickness cartilage defect.

Abstract

Background

A full-thickness knee cartilage defect requires osteoconductive properties of scaffold to improve healing. The availability and affordability of scaffolds may hinder the treatment option in some countries. A novel and more affordable cartilage scaffold of xenogeneic origin might provide an opportunity of feasibility to fill the defect.

Purpose

To investigate the short-term clinical outcomes of full-thickness cartilage defect treated with a bovine-origin cartilage scaffold after a routine microfracture procedure.
Study design: Prospective case series, Level of evidence 4

Methods

Patients with full-thickness cartilage defect who underwent microfracture and implantation of bovine cartilage scaffold were followed prospectively for at least 18 months. Clinical outcomes were examined with patient-reported scoring instruments that consisted of the Tegner Activity Scale, International Knee Documentation Committee (IKDC) subjective score, visual analog scale, and Knee injury and Osteoarthritis Outcome Score (KOOS). Pre- and postoperative scores were compared and analyzed. The association between patient age, body mass index, lesion size, or the number of treated lesions with outcome scores was evaluated.

Results

Twelve patients with a mean age of 42.5 years were evaluated prospectively for a mean of 20 months (range 19-26 months). Cartilage lesion size was recorded (median, 7.2 cm2; range, 2.4-30.2 cm2). At the final follow-up, median Tegner, visual analog scale, and IKDC subjective scores were 4, 0.4, and 86, respectively. The KOOS subset scores at the final follow-up were as follows: Pain, 95; Symptoms, 88; Activities of Daily Living, 98; Sports/Recreation, 87; and Quality of Life, 87. At the final follow-up, all scores were significantly increased ( P < .001). The rank correlation analysis showed a negative correlation between age and outcome scores of the Tegner, IKDC, and KOOS subsets of Pain, Activities of Daily Living, and Sports/Recreation. Associations between lesion size, body mass index, number of lesions, and outcome scores were not identified.

Discussion And Conclusion

A scaffold is essential to fill cartilage defect for healing. The ideal scaffold must be biocompatible, biodegradable, nontoxic, widely available, and affordable. Implantation of the novel bovine cartilage scaffold in full-thickness cartilage defect offers good to excellent clinical outcomes at short-term follow-up. This pilot study sparks the hope for more affordable treatment options for full-thickness cartilage defects.

Keywords: cartilage scaffold, chondral injury, biologic, tissue engineering