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Cartilage Regeneration Sarasota
This document discusses various cartilage repair techniques including osteochondral autografting, allografts, autologous chondrocyte implantation, and collagen scaffolds. It provides strengths and limitations of each technique. Autologous chondrocyte implantation can produce hyaline-like cartilage and fill defects of any size but is more invasive and expensive. Collagen scaffolds are used to replace injured tissue, such as the collagen meniscal implant.
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Cartilage Regeneration Sarasota
- 1. Does it Work?-MFX/PRP9 Months POST-OP Medial Femoral Condyle Trochlea Bennett Orthopedics and Sportsmedicine copyright 2012
- 2. copyright 2012 OsteoChondralAutografting Strengths: •May be performed arthroscopically •Fills defect with native cartilage Limitations: •Limited to smaller defects •Donor site morbidity •No lateral integration •Congruity of joint difficult to re-produce with multiple plugs Courtesy of Brian Cole, MD Bennett Orthopedics and Sportsmedicine
- 3. Osteochondral Allografts Strengths: •Bone fixation •Hyaline cartilage Limitations: •Limited supply •Disease transmission •Viability of chondrocytes •Non-union Bennett Orthopedics and Sportsmedicine copyright 2012
- 4. copyright 2012 BennettOrthopedics and Sportsmedicine The Augmentation of a Collagen/Glycosaminoglycan BiPhasic Osteochondral Scaffold with Platelet-Rich Plasma And Concentrated Bone Marrow Aspirate for Osteochondral Defect Repair in Sheep Getgood A. et Al. Cartilage October 3(4) 351-363, 2012 -Trend towards more normal appearing Cartilage with PRP -Trend towards better cartilage histology with PRP -Strong Type 2 collagen with PRP -less subchondarl bone cysts with plugs
- 5. copyright 2012 PestkaJM, MD, Gerrit Bode,1" MD; Gian Salzmann,1 MD, Norbert P. Sudkamp,1" MD, PhD, Philipp Niemeyer. Clinical Outcome of Autologous Chondrocyte Implantation for Failed Microfracture Treatment of Full-Thickness Cartilage Defects of the Knee Joint. American Journal of Sports Medicine, Vol. 40, 2012 Autologous chondrocyte implantation after failed microfracturing appears to be associated with a significantly higher failure rate and inferior clinical outcome when compared with ACI as a first-line treatment So What is Left if These Techniques Fail? Bennett Orthopedics and Sportsmedicine
- 6. Autologous Chondrocyte Implantation Strengths: •Can produce hyaline- like cartilage in some patients •Can fill defects regardless of size with functional repair tissue. •Moderate to large defects that have failed previous intervention Limitations: •More invasive •Expense •Longer recovery – return to sports Bennett Orthopedics and Sportsmedicine copyright 2012
- 7. Carticel Case-Steps BennettOrthopedics and Sportsmedicine copyright 2012
- 8. Cartilage Cultures Carticel-Genzyme •Biopsy, 4-6 weeks later can replant with cultured cells, use periosteal patch, open surgery •Next gen Carticel, MACI-matrix impregnated with cells, no periosteal patch Bennett Orthopedics and Sportsmedicine copyright 2012
- 9. How? SCIENTISTS WINNOBEL PRIZE FOR STEM CELLS Experiments by John B. Gurdon of the United Kingdom and Shinya Yamanaka of Japan showed that mature cells taken from the body could be changed to an embryonic- like state in a laboratory dish, a head-spinning discovery that is the biological equivalent of turning back time http://online.wsj.com/article/SB10000872396390444897304578043961363646792.html?mod=WSJ_hpp_LEFTTopStories Wall Street Journal, October 08, 2012 Without this discovery, Carticel would not be possible copyright 2012
- 10. Cartilage Cells BennettOrthopedics and Sportsmedicine copyright 2012
- 11. Children First MacmullS,*1" MBBS, MRCS (Eng), Michael T. R. Parratt,1 MBChB, MRCS (Ed), George Bentley,1 Dsc MB, ChM, FRCS, F Med Sci, John A. Skinner,f FRCS (Orth), Richard W. J. Carrington FRCS (Orth), Tim Morris. Autologous Chondrocyte Implantation in the Adolescent Knee. American Journal of Sports Medicine, Vol. 39, No. 8, 2011 Results show that, in this particular group who received ACI, patients experienced a reduction in pain and significant improvement in postoperative function after ACI or MACI. The authors believe that ACI is appropriate in the management of carefully selected adolescents with symptomatic chondral and osteochondral defects. copyright 2012 Bennett Orthopedics and Sportsmedicine
- 12. Carticel Steps BennettOrthopedics and Sportsmedicine copyright 2012 15 year old had absorbable pins for osteochondritis dissecans 2 years earlier in Port Charlotte, now with damage to cartilage from pin Preparation Drying
- 13. Carticel Steps Cont”d Bennett Orthopedics and Sportsmedicine copyright 2012
- 14. Carticel Steps Cont’d2 Bennett Orthopedics and Sportsmedicine copyright 2012
- 15. Carticel Steps cont’d3 Bennett Orthopedics and Sportsmedicine copyright 2012
- 16. Final Carticel Implant Bennett Orthopedics and Sportsmedicine copyright 2012
- 17. AMZ Adult 49y.o Female Case with Patellar Malalignment Bennett Orthopedics and Sportsmedicine copyright 2012
- 18. Carticel Malalignment Case Bennett Orthopedics and Sportsmedicine copyright 2012
- 19. Carticel 9 MonthsPost-op Bennett Orthopedics and Sportsmedicine copyright 2012
- 20. Juvenile Chondrocytes BennettOrthopedics and Sportsmedicine Regenerating the Youth in You! copyright 2012
- 21. Autologous Chondrocyte ImplantationHip Bennett Orthopedics and Sportsmedicine Regenerating the Youth in You! copyright 2012
- 22. CaReS® - CollagenMatrix Seeded with Patient’s own Chondrocytes - Custom Fit by the Surgeon to the Defect - Physical Characteristics: Resilient, Restores Biomechanical Properties of Cartilage - Launched in Germany, Austria, Switzerland in 2003 - Strong International IP position - Treated over 1100 Patients -Excellent Safety Profile -Muti-site Clincal Trials On-going -Initial Clincal Results Presented at EU Medical Conferences, Publications Pending Bennett Orthopedics and Sportsmedicine copyright 2012
- 23. Competition: -MACI, Genzyme/Verigen: autologous cells are seeded on one side of a collagen membrane, fixation is done with Fibrin Glue - Hylograft, Fidia: autologous cells are seeded in hyaluronan membrane, fixation is done with Fibrin Glue no known plans for US launch - Bio Cart, Prochon: autologous cells are seeded on a 3D fibrinogen membrane, fixation is done with Fibrin Glue - ChondroCelect, Tigenix is an improved Carticel, claims to have developed biological markers that select best chondrocytes for culture, 2 dimensional, requires sutured membrane Bennett Orthopedics and Sportsmedicine copyright 2012
- 24. Others Non USApproved as of yet Chondroselect Tigenix Hyalagraft CaRes Bennett Orthopedics and Sportsmedicine copyright 2012
- 25. Cartilage Beads BennettOrthopedics and Sportsmedicine copyright 2012
- 26. 3.) Collagen Scaffold Various Biologic scaffolds are used to replace injured tissue. Collagen Meniscal Implant(Menaflex) Graft Jacket_Rotator Cuff-human Epidermis Allograpghs- bone grafts ligaments tendons Bennett Orthopedics and Sportsmedicine Regenerating the Youth in You! copyright 2012
- 27. Meniscal Scaffold “Menaflex”Now there is a substance that can be put in when the meniscus must be removed! Bovine Collagen Bennett Orthopedics and Sportsmedicine Regenerating the Youth in You! copyright 2012