Acta Scientific Orthopaedics (ISSN: 2581-8635)

Research Article Volume 5 Issue 8

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.

Received: June 10, 2022; Published: July 12, 2022

Abstract

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

References

  1. Goldring MB and Marcu KB. “Cartilage homeostasis in health and rheumatic diseases”. Arthritis Research and Therapy 11.3 (2009): 1-16.
  2. Bark S., et al. “Enhanced microfracture techniques in cartilage knee surgery: fact or fiction?” World Journal of Orthopedics 5.4 (2014): 444.
  3. Berta Á., et al. “Clinical experiences with cartilage repair techniques: outcomes, indications, contraindications and rehabilitation”. Eklem Hastaliklari Ve Cerrahisi= Joint Diseases and Related Surgery 26.2 (2015): 84-96.
  4. Verdonk P., et al. “Treatment of osteochondral lesions in the knee using a cell-free scaffold”. The Bone and Joint Journal 97.3 (2015): 318-323.
  5. Kon E., et al. “Scaffold-based cartilage treatments: with or without cells? A systematic review of preclinical and clinical evidence”. Arthroscopy: The Journal of Arthroscopic and Related Surgery 31.4 (2015): 767-775.
  6. Sofu H., et al. “Results of hyaluronic acid–based cell-free scaffold application in combination with microfracture for the treatment of osteochondral lesions of the knee: 2-year comparative study”. Arthroscopy: The Journal of Arthroscopic and Related Surgery 33.1 (2017): 209-216.
  7. Yanke AB and Cole BJ. “Microfracture: dead or the future?” Orthopedics 37.12 (2014): 798-800.
  8. Gobbi A., et al. “Long-term results after microfracture treatment for full-thickness knee chondral lesions in athletes”. Knee Surgery, Sports Traumatology, Arthroscopy 22.9 (2014): 1986-1996.
  9. Tan SI., et al. “Biological resurfacing of grade IV articular cartilage ulcers in knee joint with Hyalofast”. Journal of Orthopaedic Surgery 28.1 (2020): 2309499020905158.
  10. Chou ACC and Lie DTT. “Clinical Outcomes of an All-Arthroscopic Technique for Single-Stage Autologous Matrix-Induced Chondrogenesis in the Treatment of Articular Cartilage Lesions of the Knee”. Arthroscopy, Sports Medicine, and Rehabilitation 2.4 (2020): e353-e359.
  11. Gobbi A and Whyte GP. “Long-term clinical outcomes of one-stage cartilage repair in the knee with hyaluronic acid-based scaffold embedded with mesenchymal stem cells sourced from bone marrow aspirate concentrate”. The American Journal of Sports Medicine 47.7 (2019): 1621-1628.
  12. Gobbi A and Whyte GP. “One-stage cartilage repair using a hyaluronic acid-based scaffold with activated bone marrow-derived mesenchymal stem cells compared with microfracture: five-year follow-up”. The American Journal of Sports Medicine 44.11 (2016): 2846-2854.
  13. Benthien JP and Behrens P. “Autologous matrix-induced chondrogenesis (AMIC). A one-step procedure for retropatellar articular resurfacing”. Acta Orthopædica Belgica 76.2 (2010): 260.
  14. Lee YHD., et al. “Autologous matrix-induced chondrogenesis in the knee: a review”. Cartilage 5.3 (2014): 145-153.
  15. Gobbi A., et al. “Treatment of full thickness chondral lesions of the knee with microfracture in a group of athletes”. Knee Surgery, Sports Traumatology, Arthroscopy 13.3 (2005): 213-221.
  16. Jones CW., et al. “Laser scanning confocal arthroscopy of a fresh cadaveric knee joint”. Osteoarthritis and Cartilage 15.12 (2007): 1388-1396.
  17. Collins NJ., et al. “Measures of knee function: international knee documentation committee (IKDC) subjective knee evaluation form, knee injury and osteoarthritis outcome score (KOOS), knee injury and osteoarthritis outcome score physical function short form (KOOS‐PS), knee outcome survey activities of daily living scale (KOS‐ADL), Lysholm Knee Scoring Scale, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Activity Rating Scale (ARS), and Tegner Activity Score (TAS)”. Arthritis Care and Research 63.S11 (2011): S208-S228.
  18. McNickle AG., et al. “Overview of existing cartilage repair technology”. Sports Medicine and Arthroscopy Review 16.4 (2008): 196-201.
  19. Siclari A., et al. “A cell-free scaffold-based cartilage repair provides improved function hyaline-like repair at one year”. Clinical Orthopaedics and Related Research®3 (2012): 910-919.
  20. Eslaminejad MB and Poor EM. “Mesenchymal stem cells as a potent cell source for articular cartilage regeneration”. World Journal of Stem Cells3 (2014): 344.
  21. Caplan AI. “Mesenchymal stem cells in regenerative medicine”. In Principles of regenerative medicine (2019): 219-227.
  22. Gobbi A., et al. “One-step surgery with multipotent stem cells and Hyaluronan-based scaffold for the treatment of full-thickness chondral defects of the knee in patients older than 45 years”. Knee Surgery, Sports Traumatology, Arthroscopy8 (2017): 2494-2501.
  23. Irrgang JJ., et al. “Development and validation of the international knee documentation committee subjective knee form”. The American Journal of Sports Medicine5 (2001): 600-613.

Citation

Citation: Prema Sivalingarajah., et al. “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". Acta Scientific Orthopaedics 5.8 (2022): 15-27.

Copyright

Copyright: © 2022 Prema Sivalingarajah., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.




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