Cell-free biomimetic scaffold for chondral and osteochondral lesions: surgical technique for custom and standardized implantation

Introduction: Cell-free chondral and osteochondral scaffolds have been introduced to address lesions of the articular surface. A proper implantation technique is key to favor scaffold integration, regenerative processes, and positive clinical outcomes. Objectives: The purpose of this article is to describe indications and surgical steps for both the custom traditional free-hand implantation approach and an innovative minimally invasive technique for the standardized implantation of this biomimetic cell-free scaffold (MaioRegen; Fin-Ceramica Faenza Spa). Methods: Indications and contraindications for this scaffold implantation have been provided. The required steps for surgical preparation, implantation technique, and postoperative management have been described as well to address articular surface lesions of the knee. Results: A dedicated instrumentation for circular implants of different sizes has been developed to allow more precise preparation of the depth and width of the defect, reducing the invasiveness and increasing implant stability. The custom free-hand technique with chisels and osteotomes remains useful when the lesion does not allow the use of the standardized instrumented technique. In case further stability of the implant is needed, fibrin glue addition should be considered. Conclusions: By guiding the readers with the key perioperative and intraoperative steps, chondral and osteochondral defects can be addressed with the use of a cell-free scaffold, maximizing implant stability.