{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T01:27:59Z","timestamp":1792114079960,"version":"4.4.0"},"reference-count":26,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2025,7,24]],"date-time":"2025-07-24T00:00:00Z","timestamp":1753315200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>This study aims to determine the clinical outcomes of a new technique of cartilage repair surgery, using calcified cartilage zone debridement coupled with Hyalofast and bone marrow aspirate concentrate, in terms of pain and functional outcomes.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>This was a retrospective case series in 19 patients with cartilage injuries, ICRS 3 and 4. Using arthroscopic examination, cartilage defects were identified and debrided. Then, the calcified cartilage zone was identified and scrapped, until punctate bleeding occurred. Hyalofast was fixed into the defect and bone marrow aspirate concentrate was injected into the Hyalofast. Patients were followed up at baseline, 1, 6, and 18 months post-operative, using visual analog scale, KOOS, IKDC, and Lysholm Score.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>The mean age was 45.33\u2009\u00b1\u20099.68 years, with the mean cartilage defects of 10.21\u2009\u00b1\u200911.10 X 9.43\u2009\u00b1\u200910.85 mm<jats:sup>2<\/jats:sup>. Among the cohort, seven patients (36.8%) underwent three chondral repair procedures, five (26.4%) received two procedures, and the remaining seven (36.8%) were treated with a single procedure. In the KOOS subscale, there was a steady improvement; symptoms (mean difference: \u221223.87, CI: \u221243.97 \u2013 \u22123.77, p-value\u2009=\u20090.015), pain (mean difference: \u221228.39, CI: \u221243.94 \u2013 \u221212.83, p-value\u2009=\u20090.001), activity of daily living (mean difference: \u221226.23, CI: \u221240.95 \u2013 \u221210.14, p-value\u2009=\u20090.001), and sports subscale (mean difference: \u221257.36, CI: \u221280.76 \u2013 \u221233.97, p-value\u2009&lt;\u20090.001).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>The calcified cartilage zone debridement technique served as a novel technique to preserve subchondral plate allowing better outcomes for cartilage repair.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0328978","type":"journal-article","created":{"date-parts":[[2025,7,24]],"date-time":"2025-07-24T17:36:06Z","timestamp":1753378566000},"page":"e0328978","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Clinical outcomes of a novel single-stage cartilage repair technique using calcified cartilage zone debridement with hyalofast"],"prefix":"10.1371","volume":"20","author":[{"given":"Badrul Akmal Hisham","family":"Md Yusoff","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Ikmal","family":"Hazli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norlelawati","family":"Mohamad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhamad Karbela Reza","family":"Ramlan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nik Kamarul Arif Bin Nik","family":"Kamrulzaman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed Razzan","family":"Rameez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4566-9704","authenticated-orcid":true,"given":"Mohamad Azwan","family":"Aziz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,7,24]]},"reference":[{"issue":"6","key":"pone.0328978.ref001","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1089\/ten.teb.2010.0191","article-title":"Articular cartilage: structure and regeneration","volume":"16","author":"J Becerra","year":"2010","journal-title":"Tissue Eng Part B Rev"},{"issue":"12","key":"pone.0328978.ref002","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.1055\/s-0040-1721053","article-title":"Management of Large Focal Chondral and Osteochondral Defects in the Knee","volume":"33","author":"JG Calcei","year":"2020","journal-title":"J Knee Surg"},{"issue":"11","key":"pone.0328978.ref003","doi-asserted-by":"crossref","first-page":"2846","DOI":"10.1177\/0363546516656179","article-title":"One-Stage Cartilage Repair Using a Hyaluronic Acid-Based Scaffold With Activated Bone Marrow-Derived Mesenchymal Stem Cells Compared With Microfracture: Five-Year Follow-up","volume":"44","author":"A Gobbi","year":"2016","journal-title":"Am J Sports Med"},{"issue":"2","key":"pone.0328978.ref004","doi-asserted-by":"crossref","DOI":"10.1002\/jeo2.12016","article-title":"Treatment of knee cartilage lesions in 2024: From hyaluronic acid to regenerative medicine","volume":"11","author":"M Brittberg","year":"2024","journal-title":"J Exp Orthop"},{"issue":"4","key":"pone.0328978.ref005","doi-asserted-by":"crossref","DOI":"10.1002\/jeo2.70060","article-title":"Microfracture for medium size to large knee chondral defects has limited long-term efficacy: A systematic review","volume":"11","author":"V Gopinatth","year":"2024","journal-title":"J Exp Orthop"},{"issue":"11","key":"pone.0328978.ref006","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1016\/j.joca.2006.05.003","article-title":"Results after microfracture of full-thickness chondral defects in different compartments in the knee","volume":"14","author":"PC Kreuz","year":"2006","journal-title":"Osteoarthritis Cartilage"},{"issue":"9","key":"pone.0328978.ref007","doi-asserted-by":"crossref","first-page":"1911","DOI":"10.2106\/00004623-200509000-00002","article-title":"The microfracture technique for the treatment of articular cartilage lesions in the knee. 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