Delayed Incorporation of a TruFit Plug: Perseverance Is Recommended

doi:10.1016/j.arthro.2009.01.023

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Volume 25, Issue 7, July 2009, Pages 810-814

https://doi.org/10.1016/j.arthro.2009.01.023 Get rights and content

Abstract

TruFit plugs (Smith & Nephew, Andover, MA) are synthetic polymer scaffolds that are inserted into an articular surface to provide a stable scaffold to encourage the regeneration of a full thickness of articular cartilage to repair chondral defects. Our unit has shown promising early results for the repair of small articular cartilage defects within the knee. Other series have reported “failures” in which patients have complained of persistent symptoms and joint effusion at 6 months after plug insertion and arthroplasty has been undertaken. We report a case of delayed incorporation of an articular cartilage defect of the lateral femoral condyle treated with 3 TruFit plugs. The patient eventually reported symptom alleviation and resumption of functional activity after 24 months of continued rehabilitation. We recommend that patients with continued symptoms persevere with rehabilitation and allow the regenerating articular cartilage time to mature fully before considering undertaking irreversible arthroplasty procedures.

Section snippets

Case Report

An 18-year-old semiprofessional footballer attended our unit complaining of pain and swelling to his knee. Two years previously, he had injured his knee, and at arthroscopy, a partial tear of the lateral meniscus was resected. The following year, he had injured his knee again, and at arthroscopy, an 8 × 10 mm area of damaged chondral surface was debrided on the lateral femoral condyle. Four months after the initial surgery, this was repaired by use of osteochondral autologous transfer with 2 ×

Discussion

Marrow-stimulation techniques consist of breaching the underlying subchondral bone with either a drill or small pick. This allows bleeding from the underlying bone and the formation of a layer of tissue (fibrocartilage) to cover the defect.⁵ These techniques have been shown to produce good symptom alleviation,⁶ but other studies have shown deterioration of outcome after 18 months.5, 7 This has been attributed to the reduced mechanical properties of fibrocartilage compared with hyaline articular

Acknowledgment

The authors thank Smith & Nephew for the technical information on the TruFit plug.

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: The authors report no conflict of interest.

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Case ReportDelayed Incorporation of a TruFit Plug: Perseverance Is Recommended

Abstract

Section snippets

Case Report

Discussion

Acknowledgment

Arthroscopy

Arthroscopy

Injury

Biomaterials

Treatment of focal articular cartilage defects in the knee: A systematic review

Clin Orthop Relat Res

Articular cartilage: Structure, injuries and review of management

Br Med Bull

Synthetic polymer scaffolds for repair of small articular cartilage defects of the knee: Early clinical and radiological results

Presented at the British Orthopaedic Association Conference, Liverpool, England, September

Case Report
Delayed Incorporation of a TruFit Plug: Perseverance Is Recommended