Cell-Free Biomimetic Osteochondral Scaffold: Implantation Technique

Andrea Sessa, Francesco Perdisa, Alessandro Di Martino, Stefano Zaffagnini, Giuseppe Filardo, Andrea Sessa, Francesco Perdisa, Alessandro Di Martino, Stefano Zaffagnini, Giuseppe Filardo

Abstract

This 1-stage cell-free scaffold-based technique is indicated for the treatment of full-thickness chondral and osteochondral lesions in the knee, regardless of the lesion size. The aim of the procedure is restoration of the osteochondral unit while avoiding the issues of donor site morbidity and those related to cell management.

Description: The surgical technique is simple and can be performed as a 1-stage procedure. The lesion site is visualized through a standard knee medial or lateral parapatellar arthrotomy. The defect is prepared by excision of the injured cartilage and subchondral bone to ensure adequate bone-marrow blood flow and to create a squared, regularly shaped lodging for the device. The scaffold is then shaped and sized according to the dimensions of the prepared lesion site and implanted by press-fitting or with addition of fibrin glue. Finally, the complete range of motion is tested to assess the stability of the implant before and after releasing the tourniquet.

Alternatives: Nonsurgical alternatives have been reported to include nonpharmacological modalities, such as dietary supplements, and pharmacological therapies as well as physical therapies and novel biological procedures involving injections of various substances1. There are several surgical alternatives, including among others microfracture, mosaicplasty, osteochondral allograft, and total knee arthroplasty, depending primarily on the disease stage and etiology as well as the specific patient conditions2,3.

Rationale: This cell-free device is engineered in 3 layers to mimic the structure and composition of the osteochondral unit in order to guide resident cells toward an ordered regeneration of both bone and cartilage layers, providing a better quality of regenerated articular surface. The treatment approach offers a useful alternative to current procedures in the field of osteochondral lesions, in particular for young and middle-aged patients affected by symptomatic defects in which subchondral bone is likely involved. The advantages of this scaffold include the ability to perform a 1-stage surgical procedure, off-the-shelf availability, a straightforward surgical technique, and lower costs compared with cell-based regenerative options. Furthermore, in contrast to some more traditional treatments, it can be used for large lesions.

Copyright © 2019 by The Journal of Bone and Joint Surgery, Incorporated.

Figures

Fig. 1
Fig. 1
The osteochondral lesion is identified and exposed.
Fig. 2
Fig. 2
A 6 to 7-mm-deep lodging with stable shoulders is created at the lesion site, using a surgical osteotome, for placement of the implant.
Fig. 3
Fig. 3
A well-defined and regular lodging area with perpendicular sides and an even, flat bed should be obtained.
Fig. 4
Fig. 4
The area is carefully cleaned of debris and sclerotic bone before applying the scaffold.
Fig. 5
Fig. 5
The scaffold is prepared, using an aluminum foil or surgical ruler, to obtain a size and shape of the graft that exactly match the prepared lesion area. The use of a scalpel is advisable to cut the superficial cartilage-like layer, while scissors are more appropriate to cut the bone-like layer.
Fig. 6
Fig. 6
The scaffold consists of 3 layers. The top (cartilage-like) layer is smooth while the bottom (bone-like) layer is rough. When applying the scaffold, the surgeon must pay attention to placing the smooth collagen (cartilage-like) layer at the top side, facing the joint. HA = hydroxyapatite. (Reproduced with permission from Fin-Ceramica Faenza.)
Fig. 7
Fig. 7
The scaffold is press-fit into the defined area. Use of fibrin glue on the upper/perimeter area of the scaffold is advised to improve stability.
Fig. 8
Fig. 8
The tourniquet is removed in order to allow the scaffold to absorb blood and be colonized by bone-marrow-derived progenitor cells.

Source: PubMed

3
订阅