Comparison of the use of 3-D scaffolding vs microfractures in the repair of total chondral defects in the knee

Nicolás Valladaresa, Monica Cabreroa, María G. Zavala-Cernab To Orthopedic Clinic b Institute of Immunology and Molecular Medicine, Faculty of Medicine, Autonomous University of Guadalajara.

Introduction

Articular cartilage injuries are found in up to 60% of patients who undergo an arthroscopic knee procedure (1), of these, those that totally affect articular cartilage (grade IV) have regenerative capacity quite limited and usually present therapeutic failure (2). This type of injury is a challenge for the specialist who treats them, 3-D scaffolds represent a novel solution to address this type of injury (3).

Objective

To retrospectively analyze the findings of MRI and function index in patients who underwent repair of chondral defects using the microfracture technique compared to the use of a 3-D scaffold.

Methods

12 patients treated with 3-D scaffolding and 21 treated with microfractures were included in this analysis. The outcomes that were taken into account were based on the MRI (Henderson) at 6 and 12 months after surgery and the score on the Cincinnati scale at 12 months. For the statistical analysis in its descriptive phase, average, SD, median and ICR were used. In relation to the inferential phase, t-student was used for comparison between groups. A significant finding was defined as p <0.05.

Results

The mean age in the microfracture group was 34.8 ± 5.1 and in the 3-D scaffold group it was 32.3 ± 6.6 (p = 0.236); the rest of the clinical and demographic characteristics were similar in both groups, as there were no significant differences between the groups. When analyzing the scores on the Cincinnati and Henderson scale, we found a significant difference in the scores from 6 months after surgery. Variable Microfractures 3-D scaffold P Henderon scale 6 months post-qx 2.76 ± 0.54 1.24 ± 0.45 P <0.001 Henderson scale 12 months post-qx 1.48 ± 0.51 1.00 ± 0.00 P = 0.0032 Cincinnati scale 12 months post-qx 80.38 ± 5.32 96.00 ± 1.28 P <0.001

Discussion

Our findings support an evident improvement in the group of patients treated with the use of 3-D scaffolding, evident from 6 months after surgery, with a total improvement evident at 12 months observed in the MRI and reported as 1 in the Henderson scale representing the absence of fluid and edema in the joint. Regarding the Cincinnati scale, we were able to observe how at 12 months the patients treated with the 3-D scaffold practically present a normal knee with the capacity to perform physical activity, while in the group treated with microfractures the highest score was related to a moderate capacity for physical activity.

Conclusion

the use of 3-D scaffolding proved to be superior in the postoperative period, with evidence of total recovery in less time.