Surface reconstruction with a biomimetic osteochondral scaffold for tibial plateau lesions: results at long-term follow-up

ABSTRACT: Introduction: Tibial plateau osteochondral lesions represent a challenge for the orthopedic surgeon, due to their frequent progression to early osteoarthritis. Objectives: The aim of the present study was to evaluate the long-term clinical results of 11 patients affected by complex tibial plateau defects treated with the implantation of an osteochondral biomimetic scaffold. Methods: Eleven patients (5 women and 6 men) with a mean age of 37.3 ± 11.0 years, affected by osteochondral lesions of the tibial plateau (5.1 ± 2.7 cm2, ranging from 3.0 cm² to 12.5 cm²) underwent implantation of an osteochondral biomimetic collagen-hydroxyapatite scaffold. Patients were evaluated preoperatively and followed-up prospectively for a mean 15-year follow-up using the International Knee Documentation Committee (IKDC) subjective score and the Tegner activity level. Results: Nine patients (81.8%) had implant survival at the final evaluation, while 2 patients required additional surgery and were therefore considered failures. The IKDC subjective score improved from 42.5 ± 10.2 preoperatively to 67.7 ± 18.4 at 5 years (P = .009), remaining higher than baseline but without statistical significance at the final follow-up (59.2 ± 19.6; P = .076). The Tegner activity level improved from 2.5 ± 2.8 preoperatively to 4.4 ± 1.9 at 2 years, followed by a modest, nonsignificant decline to 3.5 ± 1.7 at the final follow-up. Kaplan-Meier analysis demonstrated sustained scaffold survival up to 18 years. Conclusions: The implant of a biomimetic osteochondral scaffold for full-thickness defects of the tibial plateau provided a good survival rate and a positive clinical outcome up to the long-term evaluation. These results support this treatment as a joint-preserving strategy for complex tibial plateau lesions.