Abstract
Background
The management of chondral lesions in the knee, especially in young fit patients, remains an area of considerable controversy. Articular cartilage repair or reconstruction techniques may offer these patients alternatives to arthroplasty or realignment osteotomy. The TruFit plug (Smith & Nephew, London, UK) is a synthetic biphasic polymer scaffold that is designed for implantation at the site of a focal chondral defect. It is intended to resorb and allow tissue ingrowth 6-9 months following implantation and may be placed either arthroscopically or via an open approach depending on the site of the lesion.
Methods
11 patients with focal chondral defects in the knee underwent TruFit plug implantation. Postoperative management entailed a period of 6 weeks of restricted weight bearing or restricted knee flexion according to implantation site. Radiological evaluation with MRI or CT arthrogram (or both) was conducted at various time points postoperatively according to clinical indication. Functional scoring with the Oxford knee score (OKS), Tegner activity scale and Lysholm score were completed.
Results
35 TruFit plugs were implanted in 12 knees of 11 patients (4 men, 7 women) between June 2007 and December 2009. Mean age at time of surgery 46.9 years (range32-72years). Mean change in OKS 1.33 (range -13 to 29), Lysholm 13.8 (range -19 to 61), Tegner 0.33 (range -2 to 2 levels). Imaging characteristics on MRI and CT arthrogram show delayed incorporation of the grafts in all patients with no osseous integration at up to 24 months follow up.
Conclusions
Early results from the TruFit plug show variable functional outcome scores which appear independent of patient age, number of plugs used and site of implantation. All show delayed tissue integration. Our group is currently not implanting any further TruFit plugs pending longer term outcomes from larger case series.
