als PDF - AGA

27. AGA-Kongress 2010 - Wien
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New biomimetic nano-composite material for osteochondral tissue engineering: Pilot clinical
study at 3 years follow-up
Zaffagnini S., Kon E., Filardo G., Delcogliano M., Di Martino A., Marcheggiani Muccioli G.M., Marcacci
M.
Rizzoli Orthopaedic Institute, Biomechanics, Bologna, Italy
Introduction: Chondral and osteochondral articular defects represent a key concern in orthopedic
surgery. Current surgical techniques to repair osteochondral defects lead to poor subchondral bone
regeneration and fibrocartilage formation, often associated with joint pain and stiffness. From a
surgical and commercial standpoint, an ideal graft for osteochondral defect repair would be an off-theshelf
product; thus, some new biomaterials were recently proposed to induce “in situ” cartilage
regeneration after direct transplantation onto the defect site.We performed this clinical pilot study
where a newly developed biomimetic scaffold was used for the treatment of chondral and
osteochondral lesions of the knee joint in order to evaluate the safety and the reproducibility of the
surgical procedure and in order to test the intrinsic potential of the device without any other cells
culture.
Methods: A gradient composite O.C. scaffold, based on type-I collagen-HA, was obtained by
nucleating collagen fibrils with hydroxyapatite nanoparticles at physiological conditions 30 cases (9F,
21M, mean age 29,3 years) with knee osteochondral lesions (8 medial femoral condyle, 5 lateral
condyle, 12 patella, 8 femoral trochlea) were treated with scaffold implantation from January 2007 to
July 2007. The lesions size went from 2 cm2 to 6 cm2.
The clinical outcome of all patients was analyzed prospectively, at 6 moths at 1 year and 2 years using
the Cartilage standard Evaluation Form as proposed by ICRS and an high resolution MRI .
Results: Statistical analysis demonstrated a significant improvement from pre-operative to 12, 24 and
36 months follow up in all the parameter evaluated. Moreover, we observed an improvement from 12
to 24 months follow-up, and the good results obtained at 2 years were maintained at the 3 years
follow-up evaluation.
MRI evaluation was analyzed according to the MOCART scoring scale. The complete filling of
cartilage defect was noted in 80% of the patients and the congruency of the articular surface was seen
in same patients.
Conclusions: This open one-step surgery was used for the treatment of chondral and osteochondral
defects. The results of this technique are very encouraging and show satisfactory results even in big
ostechondral defects.
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