Summary

A thirteen year follow-up of clinical outcomes of patients with full-thickness cartilage lesions in the knee treated with one stage cartilage repair with hyaluronic acid-based scaffold combined with bone marrow aspirate concentrate.

Abstract

Aim

The aim of this study is to investigate the long-term outcomes of one-step cartilage repair using a hyaluronic acid-based scaffold combined with bone marrow aspirate concentrate (HA-BMAC) in treatment of full-thickness cartilage lesions of the knee.

Methods

Twenty two patients (mean age: 48.5 years) were treated for full-thickness cartilage lesions in the knee and then prospectively followed for a mean duration of 13 years (range 10 - 15 years). Median cartilage lesion size was 6.5 cm2 (range, 2-27 cm2 ). Clinical outcomes were examined using patient reported scoring system with the Knee Injury and Osteoarthritis Outcome Score (KOOS). An analysis comparing preoperative and postoperative scores was performed and also evaluating patient age, lesion size, number of treated lesions and concurrent treatment with associated procedures.

Results

Twenty one patients were prospectively followed for a mean duration of 13 years, one patient was lost to follow-up due to death. At final follow-up the median KOOS subset scores were pain - 80,33, symptoms - 80,05, activities of daily living -85,29, sports - 70,38 and quality of life - 74,86. All scores were significantly increased at final follow-up (p<0.001) compared to preoperative values. Similar median outcome scores were revealed after classifying patients by age, lesion size, treatment of multiple lesions, treatment of multiple knee compartments, and treatment by concomitant procedures. There were no complications reported. No correlation was identified between body mass index or lesion size and outcome scores.

Conclusion

In conclusion the treatment of full-thickness cartilage lesion in the knee using a hyaluronic acid-based scaffold with activated bone marrow aspirate concentrate has good to excellent clinical outcomes at long-term follow-up. The repair with HA-BMAC leads to comparatively successful long-term outcomes in the treatment of small or large lesions, single or multiple lesions and lesions in 1 or 2 compartments but also in cases with associated lesions. Also good clinical outcomes can be expected in patients over 45 years of age, but outcomes may be comparatively more successful in younger patients.