Biphasic Scaffold Loaded With Autologous Cartilage Yields Better Clinical Outcome and Magnetic Resonance Imaging Filling Compared With Marrow Stimulation for Focal Osteochondral Lesions in the Knee

Purpose: To evaluate the effectiveness of marrow stimulation (MS) versus biphasic scaffold loaded with autologous cartilage (scaffold) in treating focal osteochondral lesions of the knee. Methods: In total, 54 patients with symptomatic focal chondral or osteochondral lesion in the knee were randomized to either the scaffold group or the MS group. International Knee Documentation Committee subjective score, the Knee Injury Osteoarthritis Outcome Score, and magnetic resonance imaging (MRI) were assessed preoperatively and at 1 and 2 years after operation to compare treatment outcomes. Biopsy and second-look arthroscopy were performed at 1 year postoperatively for consenting patients. Results: There were 27 patients (mean age 31.33 +/- 10.95 years) in the scaffold group, and 27 patients (31.74 +/- 11.44) in the MS group. The scaffold group and the MS group both included 23 patients with lesions <= 12.5 x 12.5 mm(2) mm in size. In addition, each group had 4 patients with lesions between than 12.5 x 12.5 mm(2) and <= 12.5 x 25 mm(2). Both interventions achieved significant improvement in clinical outcome scores at 2 years. The scaffold group had greater International Knee Documentation Committee score than the MS group at 2 years (93.85 +/- 9.55 vs 92.11 +/- 9.84) and in the Symptoms/Stiffness and Sport/Recreation subscales of Knee Injury Osteoarthritis Outcome Score at 2 years (96.57 +/- 5.97 vs 93.57 +/- 6.52, P < .05) and (90.2 +/- 17.76 vs 82.8 +/- 16.08, P < .05). Conclusions: The use of biphasic scaffold loaded with autologous cartilage in treating focal osteochondral lesions demonstrates superior clinical outcomes and better cartilage refill on magnetic resonance imaging at the 2-year follow-up compared to marrow stimulation. Level of Evidence: Level I, Randomized controlled trial.