Multi-layer cell-free scaffolds for osteochondral defects of the knee: a systematic review and meta-analysis of clinical evidence

• Published in: Journal of experimental orthopaedics Vol. 8; no. 1; p. 56
• Main Authors: Boffa, Angelo, Solaro, Luca, Poggi, Alberto, Andriolo, Luca, Reale, Davide, Di Martino, Alessandro
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 30.07.2021; Springer Nature B.V; Wiley
• Subjects: Cartilage; Cell‐free; Clinical trials; Knee; Medicine; Medicine & Public Health; Meta-analysis; Multi‐layer; Orthopedics; Osteochondral; Review Paper; Scaffold; Statistical analysis; Surgical Orthopedics; Systematic review; Transplants & implants; Knee; Cartilage; Osteochondral; Cell-free; Scaffold; Multi-layer
• ISSN: 2197-1153; 2197-1153
• DOI: 10.1186/s40634-021-00377-4

Purpose The aim of this study was to analyze the clinical results provided by multi-layer cell-free scaffolds for the treatment of knee osteochondral defects. Methods A systematic review was performed on PubMed, Web of Science, and Cochrane to identify studies evaluating the clinical efficacy of cell-free osteochondral scaffolds for knee lesions. A meta-analysis was performed on articles reporting results of the International Knee Documentation Committee (IKDC) and Tegner scores. The scores were analyzed as improvement from baseline to 1, 2, and ≥ 3 years of follow-up. The modified Coleman Methodology Score was used to assess the study methodology. Results A total of 34 studies (1022 patients) with a mean follow-up of 35 months was included. Only three osteochondral scaffolds have been investigated in clinical trials: while TruFit® has been withdrawn from the market for the questionable results, the analysis of MaioRegen and Agili-C™ provided clinical improvements at 1, 2, and ≥ 3 years of follow-up (all significantly higher than the baseline, p  < 0.05), although with a limited recovery of the sport-activity level. A low rate of adverse events and an overall failure rate of 7.0% were observed, but the overall evidence level of the available studies is limited. Conclusions Multi-layer scaffolds may provide clinical benefits for the treatment of knee osteochondral lesions at short- and mid-term follow-up and with a low number of failures, although the sport-activity level obtained seems to be limited. Further research with high-level studies is needed to confirm the role of multi-layer scaffold for the treatment of knee osteochondral lesions.