Uploaded byAlan M. Hirahara, M.D., FRCSC
Demineralized Bone Matrix
This document discusses demineralized bone matrix (DBM) and its use in orthopedic procedures. It provides information on several DBM products, including StimuBlast, AlloMatrix, DBX, and Grafton. It describes the composition and characteristics of different DBM carriers like reverse phase medium and glycerol. The document also discusses issues like ACL tunnel widening and presents preliminary results of a pilot study examining the effect of DBM on tunnel size in ACL reconstruction. Finally, it introduces the FlexiGraft DBM product line including sponges, cortical fibers, and its applications in procedures like PASTA bridge and RC repair.
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Demineralized Bone Matrix
- 1. Demineralized Bone Matrix Alan M. Hirahara, M.D., FRCS(C) Board Certified in Orthopaedic Surgery & Orthopaedic Sports Medicine Specializing in arthroscopic shoulder surgery Medical Director Team Physician Consultant Sacramento State Athletics Sacramento River Cats Oakland A’s MiLB - AAA
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- 3. Demineralized Bone Matrix •Allograft bone with inorganic mineral removed, leaving only organic collagen matrix • Increased osteoinductivity – Exposed growth factors (BMP’s) • Requires a carrier • Many clinical studies showing efficacy but each product has different characteristics
- 4. DBM Osteoinduction Carrier Terminal Product Distributor Assay – Test % DBM (by wt) Sterility? Every Lot? RPM Yes In Vivo StimuBlast Arthrex (36) E-Beam Yes Wright CaSO4 Yes In Vitro AlloMatrix Medical (40) E-Beam Yes Na Hyaluronate In Vivo / In Vitro DBX Synthes No (32) Yes Glycerol In Vivo Grafton Medtronic No (17) No
- 5. Reverse Phase Medium(RPM) • Mod Pluronic F127 (Poloxamer PPO PEO) 5 min • More viscous at body temp • Resists irrigation, can use arthroscopically • Permeable to blood, resorbed • Metabolized readily RPM Glycerol
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- 8. Etiology of ACLTunnel Widening Biological Mechanical • Synovial fluid propagation • Graft position • Increased cytokine levels • Fixation method • Sterilization methods • Implant material • Graft type • Graft donor Maak et al. JAAOS. 2010; 18: 695-706. Fauno et al. Arthoscopy. 2005; 21(11): 1337-41. Wilson et al. AJSM. 2004; 32(2): 543-9. Darabos et al. Knee Surg Sports Traum Arthrsc; 2011; 19: S36-46. Rodeo et al. AJSM. 2006; 34(11): 1790-800.
- 9. Potential Consequences • Delayingincorporation of the soft tissue graft into bone • Decreasing graft stability • Causing difficulty with future revision surgery
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- 11. A Pilot Study: Effectof DBM on tunnel size in ACL reconstruction Alan M Hirahara, MD, FRCSC
- 12. Study Design Study Control • 11 patients • 6 patients – 6 male / 5 female – 3 male / 3 female – Age mean: 28.9 (15 – 45 yo) – Age mean: 26.6 (16 – 48 yo) • 4 revisions – 2 staged / 2 primary • No revisions • Associated pathology • Associated pathology – 2 meniscus repair – 2 menisectomy – 4 menisectomy – 3 chondroplasty – 2 microfx chondroplasty
- 13. VAS Results 6.0 5.0 4.0 3.0 2.0 1.0 0.0 Pre-op Month 1 Month 2 Month 3 Month 4 Month 5 Month 6 Study Control
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- 18. FlexiGraft • Partially demineralizedcancellous sponges – Ground – Cubes – Strips • Demineralized cortical fibers
- 19. FlexiGraft DBM Sponge • Osteoconductive • Bioactive • Natural architecture • Freeze dried • Sterile (SAL of 10-6) • Hydrophilic • Biocompatible • Customizable hydration • Malleable / Elastic / Compressible • Contains no fillers or carriers commonly used in bone putties and gels
- 20. FlexiGraft DBM CorticalFibers • Osteoconductive • Osteoinductive potential • 100% cortical • Natural architecture • Freeze dried • Sterile (SAL of 10-6) • Hydrophylic • Biocompatible • Customizable hydration • Malleable / Elastic / Compressible • Contains no fillers or carriers commonly used in bone putties and gels
- 21. FlexiGraft – PASTABridge
- 22. FlexiGraft – RCRepair
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