Systematic Review With Video Illustration
Scaffold-Based Repair for Cartilage Healing: A Systematic Review and Technical Note

https://doi.org/10.1016/j.arthro.2012.05.891Get rights and content

Purpose

The aim of this systematic review was to address the treatment of chondral and osteochondral knee lesions through the use of scaffolds, by showing surgical options and results of this scaffold-based repair approach for the healing of the articular surface.

Methods

All studies published in English addressing cartilage scaffold-based treatment were identified, including those that fulfilled the following criteria: (1) Levels I to IV evidence addressing the outlined areas of interest, (2) measures of functional or clinical outcome, (3) knee cartilage lesions, and (4) minimum of 2 years of follow-up.

Results

The analysis showed a progressively increasing number of articles per year from 1995 to February 2012. The number of selected articles was 51, with 40 focusing on 2-step procedures and 11 focusing on 1-step procedures. The evaluation of evidence level showed 3 randomized studies, 10 comparative studies, 33 case series, and 5 case reports.

Conclusions

Regenerative scaffold-based procedures are emerging as a therapeutic option for the treatment of chondral lesions, but well-designed studies are lacking. Systematic long-term evaluation of these techniques and randomized studies are necessary to confirm the potential of this treatment approach, especially compared with the available traditional treatments. Different 1-step scaffold-based strategies are emerging to simplify the procedure and reduce costs.

Level of Evidence

Level IV, systematic review of Level I to IV studies

Section snippets

Methods

All studies published in the English language addressing cartilage scaffold-based treatment were identified. Two reviewers performed a search of the MEDLINE database on PubMed from 1995 to February 2012, using the terms “autologous chondrocyte transplantation,” “second/third generation ACI,” “matrix-assisted chondrocyte implantation,” “cartilage regeneration,” “scaffold-based repair,” and “osteochondral repair.” Studies were included in the authors’ systematic review if they fulfilled the

Results

The PubMed search identified 187 articles referring to in vitro studies, 210 articles referring to animal studies, and 121 articles referring to clinical studies. The number of articles per year increased progressively from 1995, as reported in detail in Fig 1. Among the clinical studies, excluding those not fulfilling the inclusion criteria, the number of selected articles was 51, of which 40 focused on 2-step procedures and 11 focused on 1-step procedures (Tables 1 and 2). The evaluation of

Discussion

Regeneration of the articular surface is a challenge faced by both surgeons in the operating room and basic scientists in the laboratory when aiming to restore a hyaline-like cartilage with normal tissue characteristics. In fact, the growing interest in cartilage regeneration can be seen at all levels by the increasing number of publications every year that focus on this topic from the in vitro tests, preclinical animal studies, and clinical applications (Fig 1).

Research in bioengineering has

Conclusions

Regenerative scaffold-based procedures are emerging as a potential therapeutic option for the treatment of chondral and osteochondral lesions. In fact, this systematic review shows a growing interest at all levels, with an increasing number of publications every year in in vitro studies, preclinical animal studies, and clinical applications. One-step scaffold-based strategies have recently been developed to simplify the procedure, broaden the indications and further improve the results.

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