We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Implant strategy affects scaffold stability and integrity in cartilage treatment.
- Authors
Drobnic, M.; Perdisa, Francesco; Kon, E.; Cefalì, F.; Marcacci, M.; Filardo, G.
- Abstract
<bold>Purpose: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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).<bold>Conclusions: </bold>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.
- Subjects
TISSUE fixation (Histology); TISSUE scaffolds; CARTILAGE; FIBRIN tissue adhesive; ARTIFICIAL implants; HYDROXYAPATITE in medicine; COLLAGEN; PATELLA; KNEE surgery; ARTICULAR cartilage; COMPARATIVE studies; CULTURE media (Biology); DEAD; RESEARCH methodology; MEDICAL cooperation; MINERALS; RESEARCH; SUTURES; EVALUATION research; WEIGHT-bearing (Orthopedics); SURGERY
- Publication
Knee Surgery, Sports Traumatology, Arthroscopy, 2018, Vol 26, Issue 9, p2774
- ISSN
0942-2056
- Publication type
journal article
- DOI
10.1007/s00167-017-4737-x