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A pilot study of the use of an osteochondral scaffold plug for cartilage repair in the knee and how to deal with early clinical failures

Aad Dhollander UGent, KOEN LIEKENS UGent, Karl Almqvist UGent, René Verdonk UGent, Stijn Lambrecht UGent, Dirk Elewaut UGent, August Verbruggen UGent and Peter Verdonk UGent (2012) ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY. 28(2). p.225-233
abstract
Purpose: To present our short-term experience with an osteochondral scaffold plug (TruFit plug; Smith & Nephew, Andover, MA) for cartilage repair in the knee and, more importantly, to discuss our approach to treat early clinical failures. Methods: Twenty patients were consecutively treated for their cartilage lesions with the plug technique. These patients were prospectively clinically evaluated at 6 and 12 months of follow-up. Magnetic resonance imaging (MRI) was used for morphologic analysis of the cartilage repair. Biopsy samples were taken from 3 cases during revision surgery, allowing histologic assessment of the repair tissue. Results: The short-term clinical and MRI outcome of this pilot study are modest. No signs of deterioration of the repair tissue were observed. Of the 15 patients followed up during 1 year, 3 (20.0%) showed persistent clinical symptoms or even more clinical symptoms after insertion of the plug. These patients were considered as failures and therefore eligible for revision surgery. During revision surgery, the repair tissue was carefully removed. The remaining osteochondral defect was filled with autologous bone grafts. Immediate and persistent relief of symptoms was observed in all 3 patients. Histologic assessment of biopsy specimens taken during revision surgery showed fibrous vascularized repair tissue with the presence of foreign-body giant cells. Conclusions: The overall short-term clinical and MRI outcome of the osteochondral scaffold plug for cartilage repair in the knee is modest. In this pilot study a modest clinical improvement became apparent at 12 months of follow-up. MRI data showed no deterioration of the repair tissue. Of the 15 patients, 3 (20%) had persistent clinical symptoms after surgery. These patients were successfully treated with removal of the osteochondral plug remnants and the application of autologous bone grafts. Level of Evidence: Level IV, therapeutic case series.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
RELIABILITY, SCIENCE, MICROFRACTURE, TRANSPLANTATION, OSTEOARTHRITIS, DEFECTS, OUTCOME SCORE KOOS, VISUAL ANALOG SCALE, INJURY, TISSUE
journal title
ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY
Arthroscopy
volume
28
issue
2
pages
225 - 233
Web of Science type
Article
Web of Science id
000299310000014
JCR category
ORTHOPEDICS
JCR impact factor
3.103 (2012)
JCR rank
5/63 (2012)
JCR quartile
1 (2012)
ISSN
0749-8063
DOI
10.1016/j.arthro.2011.07.017
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
2055914
handle
http://hdl.handle.net/1854/LU-2055914
date created
2012-03-01 16:20:51
date last changed
2012-04-05 11:46:37
@article{2055914,
  abstract     = {Purpose: To present our short-term experience with an osteochondral scaffold plug (TruFit plug; Smith \& Nephew, Andover, MA) for cartilage repair in the knee and, more importantly, to discuss our approach to treat early clinical failures.
Methods: Twenty patients were consecutively treated for their cartilage lesions with the plug technique. These patients were prospectively clinically evaluated at 6 and 12 months of follow-up. Magnetic resonance imaging (MRI) was used for morphologic analysis of the cartilage repair. Biopsy samples were taken from 3 cases during revision surgery, allowing histologic assessment of the repair tissue.
Results: The short-term clinical and MRI outcome of this pilot study are modest. No signs of deterioration of the repair tissue were observed. Of the 15 patients followed up during 1 year, 3 (20.0\%) showed persistent clinical symptoms or even more clinical symptoms after insertion of the plug. These patients were considered as failures and therefore eligible for revision surgery. During revision surgery, the repair tissue was carefully removed. The remaining osteochondral defect was filled with autologous bone grafts. Immediate and persistent relief of symptoms was observed in all 3 patients. Histologic assessment of biopsy specimens taken during revision surgery showed fibrous vascularized repair tissue with the presence of foreign-body giant cells. Conclusions: The overall short-term clinical and MRI outcome of the osteochondral scaffold plug for cartilage repair in the knee is modest. In this pilot study a modest clinical improvement became apparent at 12 months of follow-up. MRI data showed no deterioration of the repair tissue. Of the 15 patients, 3 (20\%) had persistent clinical symptoms after surgery. These patients were successfully treated with removal of the osteochondral plug remnants and the application of autologous bone grafts.
Level of Evidence: Level IV, therapeutic case series.},
  author       = {Dhollander, Aad and LIEKENS, KOEN and Almqvist, Karl and Verdonk, Ren{\'e} and Lambrecht, Stijn and Elewaut, Dirk and Verbruggen, August and Verdonk, Peter},
  issn         = {0749-8063},
  journal      = {ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY},
  keyword      = {RELIABILITY,SCIENCE,MICROFRACTURE,TRANSPLANTATION,OSTEOARTHRITIS,DEFECTS,OUTCOME SCORE KOOS,VISUAL ANALOG SCALE,INJURY,TISSUE},
  language     = {eng},
  number       = {2},
  pages        = {225--233},
  title        = {A pilot study of the use of an osteochondral scaffold plug for cartilage repair in the knee and how to deal with early clinical failures},
  url          = {http://dx.doi.org/10.1016/j.arthro.2011.07.017},
  volume       = {28},
  year         = {2012},
}

Chicago
DHOLLANDER, AAD, KOEN LIEKENS, Karl Almqvist, René Verdonk, Stijn Lambrecht, Dirk Elewaut, August Verbruggen, and Peter Verdonk. 2012. “A Pilot Study of the Use of an Osteochondral Scaffold Plug for Cartilage Repair in the Knee and How to Deal with Early Clinical Failures.” Arthroscopy-the Journal of Arthroscopic and Related Surgery 28 (2): 225–233.
APA
DHOLLANDER, A., LIEKENS, K., Almqvist, K., Verdonk, R., Lambrecht, S., Elewaut, D., Verbruggen, A., et al. (2012). A pilot study of the use of an osteochondral scaffold plug for cartilage repair in the knee and how to deal with early clinical failures. ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY, 28(2), 225–233.
Vancouver
1.
DHOLLANDER A, LIEKENS K, Almqvist K, Verdonk R, Lambrecht S, Elewaut D, et al. A pilot study of the use of an osteochondral scaffold plug for cartilage repair in the knee and how to deal with early clinical failures. ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY. 2012;28(2):225–33.
MLA
DHOLLANDER, AAD, KOEN LIEKENS, Karl Almqvist, et al. “A Pilot Study of the Use of an Osteochondral Scaffold Plug for Cartilage Repair in the Knee and How to Deal with Early Clinical Failures.” ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY 28.2 (2012): 225–233. Print.