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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, KOEN LIEKENS (UGent) , Karl Almqvist (UGent) , René Verdonk (UGent) , Stijn Lambrecht (UGent) , Dirk Elewaut (UGent) , August Verbruggen (UGent) and Peter Verdonk (UGent)
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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.
Keywords
RELIABILITY, SCIENCE, MICROFRACTURE, TRANSPLANTATION, OSTEOARTHRITIS, DEFECTS, OUTCOME SCORE KOOS, VISUAL ANALOG SCALE, INJURY, TISSUE

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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.
@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},
}

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