Cartilage Regeneration Sarasota
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Transcript of Cartilage Regeneration Sarasota
Does it Work?-MFX/PRP
9 Months POST-OP
Medial Femoral Condyle Trochlea
Bennett Orthopedics and Sportsmedicine
copyright 2012
copyright 2012
OsteoChondral Autografting 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
Osteochondral Allografts
Strengths:
• Bone fixation
• Hyaline cartilage
Limitations:
• Limited supply
• Disease transmission
• Viability of chondrocytes
• Non-union
Bennett Orthopedics and Sportsmedicine
copyright 2012
copyright 2012
Bennett Orthopedics 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
copyright 2012
Pestka JM, 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
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
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
How?
SCIENTISTS WIN NOBEL
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
Children First Macmull S,*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
Carticel Steps
Bennett Orthopedics 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
AMZ
Adult 49 y.o Female
Case with Patellar Malalignment
Bennett Orthopedics and Sportsmedicine
copyright 2012
Juvenile Chondrocytes
Bennett Orthopedics and Sportsmedicine Regenerating the Youth in You!
copyright 2012
Autologous Chondrocyte
Implantation Hip
Bennett Orthopedics and Sportsmedicine Regenerating the Youth in You!
copyright 2012
CaReS® - Collagen Matrix 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
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
Others Non US Approved as of
yet
Chondroselect
Tigenix
Hyalagraft
CaRes
Bennett Orthopedics and Sportsmedicine
copyright 2012
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