One step surgery with a biomimetic scaffold to treat osteochondral patellar lesions: prospective study at 2 years of follow-up

Objectives: Aim of this study is to analyze the clinical outcome of an osteochondral scaffold implanted into chondral and osteohondral lesions located at the patella, site that is commonly considered as one of the more difficult to treat successfully. Methods: Forty-four patients were treated by implanting a collagenhydroxyapatite osteochondral scaffold and prospectively evaluated at initial time, then at 6, 12 and 24 months of follow-up, using the IKDC Knee documentation form and the Kujala score. They were 26 male and 18 female. Mean age was 33.2 (16–59) years, mean BMI 24.0 ± 3.0. Size of the defects was 3.3 ± 3.0 cm2. Fifteen Patients were operated for the first time and 23 of them requested combined procedures due to comorbidities. Four of them had multiple lesions. Etiology was degenerative in 29 cases, 10 traumatic and 5 were OCDs. Results: A statistically significant improvement and function recovery were recorded up to 24 months. IKDC subj score increased from 39.3 ± 15.1 to 62.6 ± 18.6 and 68.9 ± 17.8 at the 1 year and final evaluation respectively (p\0.05). Tegner score increased from 1.8 ± 1.1 to 3.6 ± 1.3 at 2 years’ follow-up (p\0.05). Three patients failed, being re-operated for the same lesion. Conclusions: The use of this biomimetic cell-free scaffold for osteochondral lesions of the patella allows to obtain function recovery and a good clinical outcome at short-term follow-up, even if lower than previously reported for other site locations. These results have to be confirmed at longer follow-up to determine the possible benefit of addressing also the subchondral bone disease.