In-Depth Oral Presentations and Oral Communications IN DEPTH ORAL PRESENTATIONS A14–KNEE Chondral lesions and tissue repair: clinical and radiological outcomes one year after post-operative application of platelet rich fibrin

Introduction Cartilage lesions are the most common cause of chronic knee pain. The current treatment options consist in conservative strategies, such as visco-supplementation and platelet-rich plasma injections, and surgical management including debridement of the chondral lesion, bone marrow stimulation with microfractures and osteochondral transplant. In this study we combined arthroscopic microfracturing with platelet concentrates, platelet-rich plasma (PRP) and Vivostat platelet-rich fibrin (PRF). Materials and methods Since September 2011 we conducted a prospective trial on 51 patients divided into 3 groups with clinical and radiological evidence of cartilage lesions. All patients underwent a knee arthroscopy with microfracture. The platelet concentrate was administered intra-operatively to the PRF group and post-operatively to the PRP group, as a cycle of 3 intra-articular injection. Finally, the microfractures group underwent only microfractures (control group). Clinical scores (IKDC, KOOS, VAS) have been administered at 6 and 12 months post-operative and was performed a radiological examination with MRI evaluating lesions of patients according to the Mocart criteria (2006). Results All patients achieved a statistically significant clinical improvement from pre-operative to post-operative time. In particular, patients who were treated with platelet concentrates achieved better clinical results compared to patients treated with microfracture only (p \ 0.0001). Comparing PRF group and PRP group patients, the first group showed a significant increase compared to the second of the IKDC scores (p = 0.0349), KOOS (p = 0.0003), VAS (p = 0.0023) at 6 months, with loss of significance at 12 months. From a radiological point of view the PRF group obtained better results earlier than the other two groups. Discussion The application of intra-operative platelet concentrate associated with microfractures has led to significant improvement 6 months postoperatively both clinically and radiologically. The rationale is that a greater concentration of platelets and growth factors leads to a greater stimulation of the bone marrow and a earlier formation of repair tissue. Conclusions Comparing Vivostat PRF application with PRP injections a more rapid and less painful recovery is evident. However, the repair tissue does not have the same characteristics of the articular cartilage. Studies of histology and microscopic anatomy are required to assess the quality of this tissue to define its characteristics.