Fibrin glue improves osteochondral scaffold fixation: study on the human cadaveric knee exposed to continuous passive motion G. Filardo, M. Drobnic,

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Fibrin glue improves osteochondral scaffold fixation: study on the human cadaveric knee exposed to continuous passive motion G. Filardo, M. Drobnic, F. Perdisa, E. Kon, M. Hribernik, M. Marcacci Osteoarthritis and Cartilage Volume 22, Issue 4, Pages 557-565 (April 2014) DOI: 10.1016/j.joca.2014.01.004 Copyright © 2014 Osteoarthritis Research Society International Terms and Conditions

Fig. 1 The osteochondral scaffolds are implanted in condyle and trochlea lesions of 2 × 1.5 cm (A), filled with blood to reproduce the initial phases of blood impregnation and coagulation in the clinical practice (B). Tips and tricks (C): if the press-fit insertion is cumbersome, to avoid deformation of the scaffold caused by friction of the lower scaffold layers with the subchondral bone, with consequent layer disruption bringing HA to the surface level, it can be helpful to accompany the insertion of the lower scaffold layers with a thin metal instrument, “shoehorn” style. Osteoarthritis and Cartilage 2014 22, 557-565DOI: (10.1016/j.joca.2014.01.004) Copyright © 2014 Osteoarthritis Research Society International Terms and Conditions

Fig. 2 Fibrin glue is applied to the bottom part of the scaffold (upper left) and its margins (lower left); then after implantation it is applied to the host–scaffold interface and implant surface (right). Osteoarthritis and Cartilage 2014 22, 557-565DOI: (10.1016/j.joca.2014.01.004) Copyright © 2014 Osteoarthritis Research Society International Terms and Conditions

Fig. 3 The lower limb is strapped to a CPM device to perform 60 motion cycles of 90 s (0°–90°–0°) (left). To simulate partial loading elastic straps are stretched between a Steinman pin in the distal femur and the foot, and a force transducer is incorporated to control the 15 kg force applied between the two joints (right). Osteoarthritis and Cartilage 2014 22, 557-565DOI: (10.1016/j.joca.2014.01.004) Copyright © 2014 Osteoarthritis Research Society International Terms and Conditions

Fig. 4 Implant appearance after CPM of press-fit implanted only scaffolds (left) or press-fit plus fibrin glue (right). Osteoarthritis and Cartilage 2014 22, 557-565DOI: (10.1016/j.joca.2014.01.004) Copyright © 2014 Osteoarthritis Research Society International Terms and Conditions

Fig. 5 No statistically significant difference in both Drobnic (upper part) and Bekkers (lower part) scores (mean and 95% confidence interval of the mean are reported) was found among implants of the trochlea, MFC, and LFC; only a tendency among press-fit implants was seen with better Bekkers scores in the MFC (P = 0.076). Osteoarthritis and Cartilage 2014 22, 557-565DOI: (10.1016/j.joca.2014.01.004) Copyright © 2014 Osteoarthritis Research Society International Terms and Conditions

Fig. 6 Similar results were obtained with the three-layer and the bi-layer scaffolds (results are reported in box and whisker plots: the central bold line representing the median, the box limits representing the quartiles, and the whiskers representing the minimum and maximum values). The only difference was found by analyzing the effect of site and scaffold together with GLM: whereas in the MFC the two scaffolds had similar results, lower scores were documented for LFC treated with the bi-layer scaffold, both with the Drobnic (upper right) and Bekkers (lower right) scores (both P = 0.04). Osteoarthritis and Cartilage 2014 22, 557-565DOI: (10.1016/j.joca.2014.01.004) Copyright © 2014 Osteoarthritis Research Society International Terms and Conditions

Fig. 7 Two bi-phasic osteochondral press-fit implanted scaffolds failed at the LFC: a marked disruption with delamination and layer dislodgement can be observed. Osteoarthritis and Cartilage 2014 22, 557-565DOI: (10.1016/j.joca.2014.01.004) Copyright © 2014 Osteoarthritis Research Society International Terms and Conditions

Fig. 8 Two possible failure mechanisms of press-fit implanted scaffolds without fibrin glue: deformation, bending, and dislodgment of the entire scaffold (left) or delamination with destruction of the cartilage layer (right). Osteoarthritis and Cartilage 2014 22, 557-565DOI: (10.1016/j.joca.2014.01.004) Copyright © 2014 Osteoarthritis Research Society International Terms and Conditions