Implant strategy affects scaffold stability and integrity in cartilage treatment.
Knee Surg Sports Traumatol Arthrosc
; 26(9): 2774-2783, 2018 Sep.
Article
in En
| MEDLINE
| ID: mdl-29022056
ABSTRACT
PURPOSE:
To identify the most appropriate implantation strategy for a novel chondral scaffold in a model simulating the early post-operative phase, in order to optimize the implant procedure and reduce the risk of early failure.METHODS:
Eight human cadaveric limbs were strapped to a continuous passive motion device and exposed to extension-flexion cycles (0°-90°). Chondral lesions (1.8 cm diameter) were prepared on condyles, patella and trochlea for the implant of a bi-layer collagen-hydroxyapatite scaffold. The first set-up compared four fixation techniques press-fit (PF) vs. fibrin glue (FG) vs. pins vs. sutures; the second compared circular and square implants; the third investigated stability in a weight-bearing simulation. The scaffolds were evaluated using semi-quantitative Drobnic and modified Bekkers scores.RESULTS:
FG presented higher total Drobnic and Bekkers scores compared to PF (both p = 0.002), pins (p = 0.013 and 0.001) and sutures (p = 0.001 and < 0.0005). Pins offered better total Drobnic and Bekkers scores than PF in the anterior femoral condyles (p = 0.007 and 0.065), similar to FG. The comparison of round and square implants applied by FG showed worst results for square lesions (Drobnic score p = 0.049, Bekkers score p = 0.037). Finally, load caused worst overall results (Drobnic p = 0.018).CONCLUSIONS:
FG improves the fixation of this collagen-HA scaffold regardless of lesion location, improving implant stability while preserving its integrity. Pins represent a suitable option only for lesions of the anterior condyles. Square scaffolds present weak corners, therefore, round implants should be preferred. Finally, partial weight-bearing simulation significantly affected the scaffold. These findings may be useful to improve surgical technique and post-operative management of patients, to optimize the outcome of chondral scaffold implantation.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Sutures
/
Cartilage, Articular
/
Fibrin Tissue Adhesive
/
Prosthesis Implantation
/
Tissue Scaffolds
Type of study:
Prognostic_studies
Limits:
Humans
Language:
En
Journal:
Knee Surg Sports Traumatol Arthrosc
Journal subject:
MEDICINA ESPORTIVA
/
TRAUMATOLOGIA
Year:
2018
Document type:
Article
Affiliation country:
Eslovenia