2017 ISAKOS Biennial Congress ePoster #206
Collagen Augmentation Improves the Quality of Cartilage Regeneration in Patients Undergoing High Tibial Osteotomy with Microfracture: A Randomized Controlled Trial
Man-Soo Kim, MD, PhD, Seoul KOREA, REPUBLIC OF
Yong In, MD, PhD, Seoul KOREA, REPUBLIC OF
In Jun Koh, MD, PhD, Prof., Seoul KOREA, REPUBLIC OF
Young Jun Choi, MD, Seoul KOREA, REPUBLIC OF
Sueen Sohn, MD, Prof., Seoul KOREA, REPUBLIC OF
Keun Young Choi, MD, Seoul KOREA, REPUBLIC OF
Seoul St. Mary's Hospital, Seoul, Seoul, KOREA, REPUBLIC OF, Seoul, , KOREA, REPUBLIC OF, Seoul, KOREA, REPUBLIC OF
FDA Status Cleared
Summary
The quality of chondrogenesis following microfracture with collagen augmentation was superior to that of microfracture only in patients undergoing high tibial osteotomy
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Abstract
Introduction
The quality of cartilage regeneration after marrow stimulation is well documented to be unpredictable, because they do not regenerate consistent amount of cartilage. To overcome the shortcomings of the microfracture technique, various augmentation techniques using synthetic collagen matrix, scaffolds or plug devices have been developed. However, their efficacy remains unclear. The purpose of this prospective randomized controlled study is to evaluate whether the microfracture in combination with collagen gel augmentation could improve the quality of cartilage regeneration in patients undergoing medial open wedge high tibial osteotomy (HTO) for the treatment of medial unicompartmental knee osteoarthritis (OA).
Methods
Twenty-eight patients undergoing HTO were randomized into two groups, microfracture alone (group 1, n = 14) or microfracture with collagen augmentation (group 2, n = 14). At 1 year postoperatively, second-look arthroscopic examination and biopsy of regenerated cartilage were performed at the time of HTO plate removal. Biopsy specimens were graded using the International Cartilage Repair Society Visual Assessment Scale II (ICRS II). In addition, radiographic outcome in terms of Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scores was assessed by MRI. Finally, the clinical outcomes in terms of visual analogue scale (VAS) pain score, Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) score, and Tegner activity scale were evaluated.
Results
The total ICRS II score in group 2 was significantly higher than that in group 1 (1053 and 885, respectively) (p = 0.002). Group 2 showed significantly greater improvements in tissue morphology, cell morphology, surface architecture, mid/deep zone assessment and overall assessment compared with group 1 (p < 0.05 for all comparisons). Radiographic outcome based on MOCART scores was superior in group 2 than in group 1 on MRI at 1 year postoperatively (65 and 45, respectively) (p = 0.001). The degree of defect repair was better in group 2 than group 1 (P = 0.04). The clinical outcomes in terms of pain VAS, KOOS, IKDC and Tegner activity scale were significantly improved in both groups without between-group differences (p > 0.1 for all comparisons).
Discussion
& Conclusion: The quality of chondrogenesis following microfracture with collagen augmentation was superior to that of microfracture only in patients undergoing HTO.