Summary

Role of PRF membrane in chondral defects of patella

Abstract

Chondral defects are seen in 34%–62% of knee arthroscopies , while full-thickness focal lesions with an area of at least 1–2 cm in patients younger than 40 year.
A recent systematic review of microfracture concluded that early treatment of chondral defects with microfracture is associated with positive clinical and histologic outcomes. The biggest drawback of marrow-stimulating techniques is that the newly formed fibrocartilage, a form of Type I cartilage, has less mechanical stress resistance than native cartilage, the number of stem cells procured is also low .
Hence to overcome the issues of microfracture, We incorporated PRF membrane in it to enhances regeneration of soft tissues and bone as it contains meshed fibrin matrix, platelet incorporation, leucocytes, circulating stem cells, cytokines and various growth factors which allow optimal healing , angiogenesis, low costs, and complete immune-biocompatibility . It also present antinociceptive effects through, anti-inflammatory cytokines, and opioid peptides.
Methodology- In this comparative study, 30 patients with full thickness chondral defect of patella with age from18-40 yrs
Patients divided in groups ,
Group 1 Chondral defect of patella .with arthroscopic debridement along with micro fractures.
Group Chondral defect of patella with arthroscopic debridement along with micro fractures + PRF membrane

Results

After a baseline pre-operative evaluation, patients were assessed at two weeks, six weeks, and three months, 6 months,12 months with clinical, radiological, and biological evaluation. The assessment included evidence of infection and local pain graded by the visual analogue scale Mean (VAS)Score has decreased Group 1 from (8.3 to 3.2) vs Group 2 the mean of (8.9 to 2.4) no significant difference was seen with in groups after 12 months
Kujala Score in Group 1 improved from (33.93 to 76.4 ) Vs Group 2 ( 32.4 to 90.27) Shows significant difference among groups after 12 months P<0.05
We independently assessed each WOMAC dimension, specifically pain, stiffness, and functional capacity. Most patients Group 1 (67.7% vs Group 2(80.7%) reported mild pain while walking on flat terrain, Group 1 (26.0 %)Vs Group 2 (15.3% )reported moderate pain while using stairs, and Group 1 (6.3%) Vs Group 2(3.9%) reported moderate pain while sitting . Regarding return to sport, 70% of our patients in Group 2 as compare to group 1 - 56% reported returning to sport at a level equal to their preinjury level.
Healing evaluation with MRI Scanning Analysis of each category included in the MOCART score showed that nearly 67% of patients had a complete hypertrophic repair of the defect in Group 2 as compare to Group 1 with 54%.. Furthermore, 77% of patients had a defect filling greater than 50%, in group 2 vs group 1- 64%. We evaluated the biologic response with IL-6 and TNF-a. In group 2 there is significant decrease in Inflammatory biomarkers as compare to group 1 P<0.01

Conclusion- Hence it can be concluded that PRF showed good osseous integration and excellent filling of the chondral surface, as evidenced. PRF is a good alternative to treat patellar chondral defects, especially among young patients.


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