Clinical Outcomes of Hyaluronic Acid–Based Scaffold Augmentation in Microfracture Treatment for Focal Osteochondral Defects in The Knee: A Retrospective Comparative Study

Abstract

Aim: Microfracture is a common, cost-effective treatment for focal osteochondral defects (FCDs) of the knee. However, it often results in fibrocartilage with poor biomechanical properties. Hyaluronic acid–based biodegradable scaffolds like Hyalofast® have been developed to enhance cartilage regeneration and improve outcomes. Material and Method: This retrospective study included patients with knee FCDs smaller than 3 cm², treated between 2015 and 2018. Two treatment groups were compared: microfracture alone versus microfracture combined with a hyaluronic acid–based scaffold. Clinical outcomes were assessed using Visual Analog Scale (VAS), International Knee Documentation Committee (IKDC), and Knee Injury and Osteoarthritis Outcome (KOOS) scores preoperatively and at 6 months postoperatively. Results: Both groups showed statistically significant improvements in all clinical scores after treatment (p<0.001). Although postoperative VAS and KOOS scores did not differ significantly between groups, the scaffold-augmented group achieved significantly higher IKDC scores compared to the microfracture-only group (66.35±6.00 vs. 62.08±8.51, p=0.04). Conclusion: These findings suggest that while microfracture remains a valuable primary treatment for focal cartilage defects, scaffold augmentation may confer an additional functional benefit. Further prospective studies with long-term follow-up are warranted to confirm the clinical durability of scaffold-assisted cartilage repair strategies.

Keywords

• Cartilage
• knee joint
• osteochondral allograft transplantation
• hyaluronic acid
• tissue scaffolds

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