Comparative efficacy of synthetic peptide, platelet-rich plasma, and hyaluronic acid alone or in combination in microfracture treatment of focal chondral defects

Aim: Although previous limited studies have evaluated the efficacy of adjuvants used alone or in combination to augment microfracture (MF) treatment for focal chondral defects, there are no studies comparing the outcomes of the synthetic peptide (SP) with other adjuvants such as platelet-rich plasma (PRP), hyaluronic acid (HA), or their combinations. This study aimed to evaluate whether the efficacy of MF treatment in focal chondral defects is influenced by the use of adjuvants either alone or in combination. Material and Methods: Thirty-six rats were included in the study. Group 1 received MF alone, Group 2 received PRP after MF, Group 3 received HA after MF, Group 4 received a SP after MF, Group 5 received a SP plus PRP therapy after MF, and Group 6 received a SP plus HA therapy. The knees of the rats were assessed according to the International Cartilage Repair Society (ICRS) Cartilage Repair Assessment 1 (ICRS-1) and 2 (ICRS-2). Results: The median ICRS-1 and ICRS-2 scores in Group 1 were lower compared to the other groups, while these scores in Group 2 and Group 4 were similar and higher than the other groups. Also, these scores in Group 5 and Group 6 were similar and lower compared to Group 3 (Group 1: 1 vs. Group 2: 12 vs. Group 3: 9 vs. Group 4: 11 vs. Group 5: 7 vs. Group 6: 7, p < 0.001 for ICRS-1 scores; Group 1: 0 vs. Group 2: 85 vs. Group 3: 70 vs. Group 4: 80 vs. Group 5: 45 vs. Group 6: 45, p < 0.001 for ICRS-2 scores). Conclusion: In the MF treatment of focal chondral defects, SP, PRP, and HA injections have a beneficial adjuvant effect based on macroscopic and histopathological findings. However, the combination of these adjuvants is less beneficial than their individual usage.