04 Articular Cartilage 2 Flashcards Preview

7212 Pathophysiology > 04 Articular Cartilage 2 > Flashcards

Flashcards in 04 Articular Cartilage 2 Deck (38):
1

What are the surgeries for articular cartilage lesions?

- tibial osteotomy
- lavage
- chondroplasty
- microfracture
- mosaicplasty-autografts
- OATS-autografts
- osteochondral allografts
- ACI
- MACI
- DeNova

2

Which surgery is performed for chondral lesions?

tibial osteotomy

3

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

4

What types of lesions is lavage used for?

incomplete lesions of articular cartilage

5

When did results decline for lavage?

exposed, eburnated, subchondral bone

6

controlled study on lavage outcomes

- pts with OA of the knee
- outcomes after lavage or debridement were NO BETTER than after a placebo procedure

7

When would a chondroplasty be performed?

grade III defect

8

chondroplasty aka

abrasion arthroplasty

9

microfracture for chondral defects

- use of an awl to create indentations in subchondral bone
- induces mesenchymal clot formation

10

mosaicplasty-autografts

autograft bone plugs from superior lateral trochlea fills in the damaged area

11

What does OATS stand for?

Osteochondral
Autograft
Transfer
System

12

OATS is similar to

mosaicplasty
- just uses bigger plugs

13

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

14

What are osteochondral allografts?

harvest a plug from donor tissue and cut to size

15

Is there an advantage to using osteochondral allografts over an autograft?

yes

you can resize, smooth, and make it the perfect size

16

What does ACI stand for?

autologous chondrocyte implantation

17

What are other names for ACI

- ACI (procedure)
- Genzyme (company)
- Carticel (cartilage stimulated and put back in)

18

What is ACI the precursor to?

MACI
DeNova

19

What is the first generation ACI procedure?

P-ACI (periosteum based)

20

What are the problems with the periosteum based ACI procedure?

- 2 stage procedure
- $25,000

21

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)

22

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

23

long term outcomes of ACI

- improving over time***
(one of the best long term procedures)

- most other surgeries show poor outcomes with time

24

rehab for ACI (Carticel recommendations vs. in practice)

- Carticel recommends CPM, NWB
- CPM actually ended up taking off the chondrocyte patch in some patients

25

What is the second generation ACI procedure called?

MACI

matrix based ACI

26

What is the overall MACI procedure?

suspended cultured chondrocyte cells covered by collagen membrane

27

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

28

1st gen MACI

periosteal patch

29

2nd gen MACI

mesh material

30

3rd gen MACI

collagen

31

4th gen MACI

gel based

32

What does the DeNova procedure use for allografts?

- juvenile allografts
- consists of scaffold free, living articular cartilage

33

Why use juvenile allografts?

young, healthy chondrocyte cells have higher growth potential

34

Overall: what are the current treatment options for cartilage defects?

- osteochondral grafting (autograft/allograft)
- marrow stimulation
- cell transplantation

35

Which procedures fall under the marrow stimulation category?

- microfracture
- retrograde drilling

36

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

37

return to activity: fastest to longest

1. arthroscopic debridement (chondroplasty)
2. marrow stimulation (microfracture)
3. osteochondral autograft/allograft
4. ACI/MACI

38

With respect to return to activity, what must also be the case?

- should return with no pain or effusion
- do MMT and functional testing