Midterm Clinical Outcome of Single-Stage Knee Articular Cartilage Repair Using Hyaluronic
Acid-Based Scaffold Embedded with Bone Marrow Aspirate Concentrate (HA-BMAC) Combined with Microfracture
Prema Sivalingarajah*, Siti Hawa Binti Tahir, Siva Thangaraju,
Muhammad Hafiz Bin Daud, Duratul’ain Binti Mohamad Nazri
and Charles Ang Poh Thean
Master of Orthopedic Surgery, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
*Corresponding Author: Prema Sivalingarajah, Master of Orthopedic Surgery, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia.
June 10, 2022; Published: July 12, 2022
Introduction: Single-stage knee articular cartilage repair using Hyaluronic Acid-based scaffold embedded with bone marrow aspirate concentrate combined with microfracture (HA-BMAC-microfracture) is a significant advancement in the treatment of chondral injury.
Objectives: To investigate the midterm clinical outcome of knee cartilage repair treated with HA-BMAC-microfracture.
Methods: Clinical outcomes were assessed via patient-reported scoring tools, namely the International Knee Documentation Committee (IKDC), subjective function score (Lysholm score), ability to return to sports and performing daily prayers in a normal manner. They were assessed preoperative, at short-term follow-up (1 year and 2 years postoperative), and at mid-term follow-up (4 years postoperative).
Results: Twenty-four patients fulfilled the criteria, mean age 36.7 years. Mean IKDC score showed statistically significant (P value < 0.001) increase from preoperative to 1year postoperative (65.2), from preoperative to 2 years postoperative (62.6) and from preoperative to 4years postoperative (58.2). Lysholm score also showed statistically significant (P value < 0.001) increase from preoperative to 1 year postoperative (56.6), from preoperative to 2 years postoperative (54.9), and from preoperative to 4 years postoperative (46.5). On the ability to return to sports also showed statistically significant outcomes. From preoperative to 1 year postoperative (P value 0.031), to 2 years postoperative (P value 0.031) and to 4 years postoperative (P value 0.031). However, the proportion of return to sports from 1 year to 2 years postoperative (P = 1.00), to 4years post operative (P = 1.00) and from 2 years to 4 years postoperative (P = 1.00) was not statistically significant. Similarly, the proportion of individuals able to perform daily prayers in a normal manner also showed statistically significant improvement. From preoperative to 1 year postoperative (P value 0.021), to 2 years postoperative (P value 0.008), and to 4 years postoperative (P value 0.008). There was no significant difference in the proportion of prayer outcomes from 1 year to 2 years postoperative (P value 1.00), to 4 years postoperative (P value 1.00) and from 2 years to 4 years postoperative (P value 1.00).
Conclusion: HA-BMAC-microfracture for the treatment of knee cartilage injury provides a good clinical outcome at short and mid- term follow up. Despite good clinical outcome, none of the patients were able to return to pre- injury level sports and all patients with patellofemoral lesion did not return to praying normally.
Keywords: Chondral Injury; Biological Scaffold; Hyaluronic Acid Scaffold; Bone Marrow Aspirate Concentrate; Platelet- Rich Plasma; HA-BMAC
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