Summary

The main objective of this study is to evaluate whether subchondroplasty combined with knee arthroscopy is more effective in reducing knee pain and improving function and to evaluate cartilage development in chondral lesions. All results of knee function were evaluated by functionality test, nano arthroscopy, Mappin magnetic resonance imaging, and immunohistochemical study.

Abstract

Introduction

To evaluate the efficacy of arthroscopic cleaning associated with subchondroplasty with Platelet Rich Plasma and intra-articular infiltration, in the development of articular cartilage, joint function and pain.
Material and methodology
Longitudinal, descriptive, prospective study.
Period from January 2018 to December 2022.
63 patients, 46 male, 17 female. (Weight 76 ± 5.2 kg height 1.78 ± 4 cm and a body mass index 25.3 ± .1 kg/m²
Average age 34 years.
Median follow-up of 18 months
Chondral lesion in the medial condyle, 38 patients, external condyle 25 patients. Right knee 41 patients, left knee 22 patients.
Chondral lesions according to ICRS classification grade 2, 45 patients, grade 3, 18 patients.
Physical examination shows quadriceps atrophy, mean range of motion in extension is 170° and in flexion 120°.
The patients were evaluated prior to the intervention by magnetic resonance imaging (Philips) 1.5 tesla, with sequences T1, T2, TSE, Mapping. (40 patients)
Another group of patients was evaluated by Nano Arthroscopy (Trice Medical). (23 patients).
Once the injury was diagnosed, we performed knee arthroscopy, arthroscopic cleaning of the joint, and of the area of the chondral defect. We perform subchondroplasty with Platelet Rich Plasma in the distal femur, proximal tibia (7 milliliters), then we infiltrate intra-articularly (7 milliliters).
In 10 patients we took a sample for immunohistochemical study, at 14 weeks post surgery.

Results

The results by means of Magnetic Resonance (Mapping) show development of articular cartilage at an average of 14 weeks post surgery.
Nano Arthroscopy confirms the development of cartilage at 14 weeks. During the procedure we took a sample for an immunohistochemical study, the report of the samples indicates: presence of predominant fibrocartilage, associated with zones of type 2 collagen.
The functional evaluation using the Lysholmm scale prior to surgery gives a mean score of 54/100 points, after surgery 95/100 points.
Visual Analog Scale average value of 1.39 points.
Weight bearing in the affected limb was allowed 7 days after surgery, with a return to normal activities at 63, 6 days on average.

Conclusions

Arthroscopic joint cleaning associated with subchondroplasty with Platelet Rich Plasma and intra-articular infiltration is an alternative for the treatment of chondral lesions, improving subchondral and intra-articular homeostasis, allowing cartilage regeneration in lesions smaller than 1.5 cm2, reducing pain and improving range of motion of the joint.