Basics of Cartilage Restoration Introduction of TruFit™ · PDF fileBasics of Cartilage...

Basics of Cartilage RestorationIntroduction of TruFit™

Philip A. Davidson, MDHeiden Orthopaedics

Park City, Utah USASmith & Nephew Seminar

London, UKOctober 2008

Davidson - Cartilage Restoration

Cartilage RestorationA wide realm between…..

Arthroscopic debridement


Goals: Biological Cartilage Restoration

Relieve pain Restore functional

histologic architecture Improve Mechanics Long lasting Prevent or Limit

Future Degenerative Changes


Goal of Cartilage RestorationReplicate Hyaline Articular Cartilage


Common Biological Treatment Options for Cartilage Defects - 2008

< 1 cm2

MSTMosaicplasty

>4 cm2

MSTAllo OAT

Chondrocytes

1 – 4 cm2

DebridementMST

MosaicplastyAllo OAT

Chondrocytes


Marrow Stimulation Techniques

- Drilling- Picking- Abrasion- Microfracture

Marrow stimulation results:

- Fibrocartilage Limited potential with

increased age, injury chronicity

Cheap, fast, easy Short term efficacy

seductive.


Biological Options

Autologous Chondrocytes ACI MACI

Osteochondral Grafts Autogenous Allogeneic

Biologically Active Scaffolds


Additional biologic treatment options

Minced allografts Enhanced autografts Hydrogels Orthobiologic

Scaffolds SNE- OBI plugs Biomet - Osseofit


Comprehensive Knee Treatment

Articular Cartilage restoration not in isolation Stability Alignment Meniscal status


Stimulants:Wound Site

Cells:Patient

Scaffolds:Orthobiologic Implant

Surgical Technique +

Rehab

What is needed for osteochondral healing?


ORTHOBIOLOGICS Tissue engineering

concept –integrative Scaffold Cells/genes Bioactive

agents/molecules/ factors


Where does orthobiologic osteochondral scaffold fit in?

Off the shelf alternative better than microfracture

Less morbidity than mosaicplasty

Fill donor sites mosaicplasty

No allograft donor issues Smaller type defects

< appx 2cm


Orthobiologic graft has several appealing features

No bridges burned Immediate smoothing Easy technique Readily available Minimally invasive Biological alternative Immediate Pain relief No risk of disease

transmission Patient acceptance


Orthobiologic Scaffold-How it Works

Keeps blood / cells where they need to be during healing Solid construct prevents

formation of fibrous tissue Clean cut / press fit gives

good host-implant contact Optimized pore size for

chondrocyte and cellular migration Provides gradual loading

as tissue matures


What does the Plug Provide? Multilayered product Each layer is designed to

match the physical and mechanical properties of the adjacent tissue

Absorbable Composed of:

Poly(D,L-lactide-co-glycolide) Calcium sulfate PGA fibers-

reinforcement beams Trace amount of

surfactant

articular cartilage

tidemark

subchondral bone


TRUFIT™ CB Plugs

Preformed circular plugs with diameters ranging from 5 to 11 mm

Ideal for filling circular drill holes in bone, 6-17 mm deep

Allows for tissue regenerationPress fit into defect site to maintain

space

Patent 5,607,474 plus others issued and pending


TRUFIT™ CB Angled Plugs Treatment of osteochondral defects of the

medial or lateral aspect of the talus Offered in 5 mm, 7 mm and 9 mm Custom delivery devices and defect creation

tools for accurate installation of the implants


TRUFIT™ CB Saddle PlugPlug geometry mimics trochlea surfaceClear outer sleeve to aid in visualizationAvailable in 2 diameters: 9 and 11mmMarkings at ends help in orientation


6 Weeks post-op Blood, marrow, cells are

contained in pores Intimate contact to

promote good contact and enhance integration Entire scaffold is filled

with new tissue Defect walls are

maintained Bone is infiltrating the

scaffold from the periphery


6 months-trochlear groove and medial femoral condyle

Preclinical Testing


Preclinical Testing12 months histology

trochlear groove

femoral condyle

Treated with TruFit Empty - femoral condyle

Jackson, et al.


Preclinical Testing12 months histology close-ups

trochlear groove femoral condyle

Repair tissue exhibits normal cellular structure

Stains positively for type II collagen


Thank You [email protected]

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Basics of Cartilage Restoration Introduction of TruFit™ · PDF fileBasics of Cartilage...

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