Biologic Augmented Scaffold-based cartilage repair: Addressing Complications and Enhancing Outcomes

Abstract

Cartilage repair remains a significant challenge due to the tissue's limited innate regenerative capacity. Despite advances in techniques such as microfracture, autologous chondrocyte implantation (ACI), and osteochondral grafting, long-term outcomes are often compromised by complications, including suboptimal tissue integration, graft resorption, and mechanical instability. Recently, biologically augmented scaffold-based cartilage repair has emerged as a promising approach for full-thickness osteochondral lesions. These techniques combine acellular scaffolds with biologic agents, such as bone marrow aspirate concentrates (BMAC), to enhance tissue regeneration, reduce inflammation, and promote healing. However, postoperative complications—such as graft hypertrophy, arthrofibrosis, graft hypotrophy, and graft dislodgement—continue to pose challenges to successful outcomes. This paper presents case studies illustrating the clinical presentation, diagnosis, and management of these complications. Early recognition through clinical evaluation and imaging, followed by timely intervention, proved essential in mitigating the long-term effects of these complications. Although biologically augmented scaffolds offer potential advantages, variability in outcomes remains due to differences in biologic composition, scaffold design, and patient factors. The findings highlight the importance of individualized treatment strategies and adherence to postoperative rehabilitation protocols to reduce the risk of complications. Further research is needed to optimize biologic augmentation protocols and scaffold designs to improve long-term cartilage repair outcomes.