Flashcards in 04 Articular Cartilage 2 Deck (38):
What are the surgeries for articular cartilage lesions?
- tibial osteotomy
- osteochondral allografts
Which surgery is performed for chondral lesions?
What is the rationale behind lavage?
- wash out the joint
- believed to remove the mediators of inflammation and any loose, free flaps or pieces of cartilage that may be present
- relieves symptoms
What types of lesions is lavage used for?
incomplete lesions of articular cartilage
When did results decline for lavage?
exposed, eburnated, subchondral bone
controlled study on lavage outcomes
- pts with OA of the knee
- outcomes after lavage or debridement were NO BETTER than after a placebo procedure
When would a chondroplasty be performed?
grade III defect
microfracture for chondral defects
- use of an awl to create indentations in subchondral bone
- induces mesenchymal clot formation
autograft bone plugs from superior lateral trochlea fills in the damaged area
What does OATS stand for?
OATS is similar to
- just uses bigger plugs
Where are the plugs harvested from for an OATS procedure? Why?
- superior lateral trochlea
- want to get them from the surface with the least amount of articulation during normal movement
What are osteochondral allografts?
harvest a plug from donor tissue and cut to size
Is there an advantage to using osteochondral allografts over an autograft?
you can resize, smooth, and make it the perfect size
What does ACI stand for?
autologous chondrocyte implantation
What are other names for ACI
- ACI (procedure)
- Genzyme (company)
- Carticel (cartilage stimulated and put back in)
What is ACI the precursor to?
What is the first generation ACI procedure?
P-ACI (periosteum based)
What are the problems with the periosteum based ACI procedure?
- 2 stage procedure
What is the first part of the ACI procedure?
- harvest healthy chondrocyte cells with a syringe (about 1 million)
- cartilage cells sent to Genzyme (creates 10 million from the original)
What is the second ACI procedure?
- harvest a second patch from medial flare of tibia
- sew patch around OCD lesion
- inject stimulated chondrocyte cells back into the OCD lesion
long term outcomes of ACI
- improving over time***
(one of the best long term procedures)
- most other surgeries show poor outcomes with time
rehab for ACI (Carticel recommendations vs. in practice)
- Carticel recommends CPM, NWB
- CPM actually ended up taking off the chondrocyte patch in some patients
What is the second generation ACI procedure called?
matrix based ACI
What is the overall MACI procedure?
suspended cultured chondrocyte cells covered by collagen membrane
What is the rationale behind MACI?
- provides a better foundation for chondrocyte cells
- isolated cells are stimulated, injected into the matrix, and placed into the OCD lesion
1st gen MACI
2nd gen MACI
3rd gen MACI
4th gen MACI
What does the DeNova procedure use for allografts?
- juvenile allografts
- consists of scaffold free, living articular cartilage
Why use juvenile allografts?
young, healthy chondrocyte cells have higher growth potential
Overall: what are the current treatment options for cartilage defects?
- osteochondral grafting (autograft/allograft)
- marrow stimulation
- cell transplantation
Which procedures fall under the marrow stimulation category?
- retrograde drilling
articular cartilage defects and implications to rehab
- doc gives you a sheet telling you where the lesion is
- chart tells where you need to be cautious to avoid shear stresses on the joint
return to activity: fastest to longest
1. arthroscopic debridement (chondroplasty)
2. marrow stimulation (microfracture)
3. osteochondral autograft/allograft