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Current Concepts for Cartilage Defect Treatment OptionsFrank McCormick M.DSamuel Rosas MSIVwww.FrankMcCormickMD.comLESS Surgical InstituteShoulder and Sports DivisionMiami/Fort Lauderdale/Boca Raton/West Palm Beach/ Orlando

1AgendaCartilage physiology Cartilage defectsEpidemiology Current Modalities of treatmentFuture of cartilage injury treatment 1.2.5.3.4.6.Summary and Questions

Cartilage Physiology

http://dancehealthier.com/tag/does-cartilage-repair-itself/4

http://www.emedx.com/emedx/diagnosis_information/knee_disorders/knee_normal_articular_cartilage.htm

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http://snoworthopaedics.com/portfolio/cartilage-injuries/Causes:TraumaSports injuriesOsteochondritis dissecansPanner diseaseOA more than 20 million americans by 2020

6Epidemiology66% of patients had a cartilage defect N= 993

11% full thickness pathologyAthletic population:

N= 99336% full thickness lesion2 Million Ankle sprains per yea. 50% likely result in a chondral defect

Diagnosis

T1 image showing PF defect on medial aspect of the patella

McMurray 50% Sensitivity. 73% specificity on meta-analysisJoint line tenderness 63%. S 77%

8Why treat?

1. Conservative treatment

2. Micro-fracture

3. Autologous Chondrocyte Implantation

4. Biological Approach

5. Different Graft optionsSummary of treatment options

G. Bentley et al. / Injury, Int. J. Care Injured 44 (2013) S3S10

Conservative ManagementNSAIDSPhysical therapyChondritin SulfateActivity Modification

Mostly used when no diagnosis has been made or by patient preferenceRemember we treat patients not mris or xrays

12-Bone marrow stimulation technique

-Can be done arthroscopically

-No additional cost to the procedure

-No difference vs OAT vs chondroplasty in 32 patients at mean follow up period of 33 months.

-Best for small defects: less than 15mm

-Great option for competitive athlete who needs quick recovery

-Beyond 5 years, treatment failure may be expected

Microfracture

Best for:Small lesions defines as under 2.5cmPatients that have low postop demandsBeyond 5 years, treatment failure may be expected

MF vs AOT VS chondroplasty all did well and no statistical difference was apparent at 33 months using the AOFAS scale

OAT: osteochondral autolugus transplant13-Using a transplant from a fresh cadaver-Used for larger defects-Bacterial and PCR testing must be done first-transplant intact cartilage and bone-Only available in US

Osteochondral allograft transplantation

Autologous Chondrocyte Implantation ACI

Started in Sweden by Peterson in 1987

77% SATISFACTORY RESULTS AT 5 YEARS WITH THE USE OF ICRS, LYSHOLM, SF 36 FORM AND TEGNER SCORES HIGH BMI GREATER THAN 25 AND SMOKING DECRESE SUCCES RATESInjury, Int. J. Care Injured 44 (2013) S1, S3S10

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BEST OUTCOMES:Young patients