Amniotic Membrane Tissue Allografts: Arthrofibrosis & TKR
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1 Amniotic Membrane Tissue Allografts: Arthrofibrosis & TKR Orthopaedic Summit 2017, Evolving Techniques M ichael J. K aplan M D Disclaimer: Consultant for MiMedx
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3 Normal Wound Healing Physiology Inflammation > H ours to D ays Proliferation > D ays to W eeks R emodeling > W eeks to M onths
4 Modulation of Inflammation Proper Balance of Pro & Anti-inflammatory signals C hronic inflammation H omeostasis altered by imbalance of immunoregulatory cytokines M olecular mediators, extracellular matrix, ph, and nutritional environment all play some role
5 Cell Proliferation Inflammation subsides Stem cells migrate and proliferate to replace damaged tissue E xtracellular M atrix > G ranulation T issue A ngiogenesis
6 Remodeling Disorganized scar removed T issue synthesis and degradation by M M Ps ( M atrix M etalloproteinases) E xcessive fibrous tissue proliferation results in scarring
7 Science: American Journal of Sports Medicine Amniotic M embrane Study in Rats: David Kovacevic M.D. Yale University R esults: I ncreased fibrocartilage Promotes bone healing Promotes C OL -1 and MMP-2 expression T ranslates Fibroblastic granulation tissue to more mature, organized collagen N o immunogenic host response to allograft
8 Science: American Journal of Sports Medicine Human Amniotic Membrane - D erived Products in Sports Medicine Basic Science, E arly R esults, and Potential C linical Applications R iboh, Saltzman, Yanke, C ole, N ovember 19, 2015 Systematic R eview of L iterature C onducted 6,870 Articles Screened, 80 R elevant to T opic
9 Science: American Journal of Sports Medicine Conclusions: Amniotic membranes have promising applications in Sports M edicine T hey are a source of pluripotent cells, highly organized collagen, antifibrotic and anti-inflammatory cytokines, immunomodulators, and matrix proteins. I mproves tissue organization in healing and the treatment of the arthritic joint
10 Science: American Journal of Sports Medicine Conclusions Continued: T he evidence in sports medicine is heavily biased toward in vitro and animal studies with little to no human clinical data 14 companies or distributors offer commercial amniotic products Preparations and formulations differ, and an understanding of their distinctions will guide their use in sports medicine research
11 Amniotic Allografts Improved technology U ltimate biologic for healing and regeneration H istorically sound principles M odulates inflammation R educes scar tissue formation
12 Tissue Allograft: MiMedx Dehydrated for preservation Inhibits viability of microorganisms Retains biologic activity E asy storage and handling properties Once rehydrated, tissue matrix is bioactive
13 Immunologically Privileged No host rejection > L ow levels of Antigens Biological Barrier M odulates inflammation D ecreases scar Formation E nhances soft tissue healing
14 Mesenchymal Stem Cells Self -renewing > dividing and replicating E mbryonic stem cells > Pluripotent (i.e. no limitations) C an develop into any of the three germ layer types D ifferentiate and therefore valuable for tissue repair
15 Human Amnion Chorion Membranes d-h AC M : Dehydrated H uman Amnion C horion M embrane 226 G rowth Factors, C ytokines, and R egulatory molecules which modulate healing identified All can influence cell behavior
16 History Clinical applications for greater than one hundred years 1910: skin transplantation, 1960: burns and chronic wounds T hree hundred articles for various indications R andomized studies show reduced scarring w/laminectomy Prostate surgery & craniotomy procedures
17 Total Knee Arthroplasty Experience With Allograft Membrane Over 190 TKRs supported with amniotic membranes Over 125 with amniofix membranes 65 Patients with AmnioC ord
18 Empirical Findings Patients have increased ROM D ecreased incidence of M U A 7/190 L ess pain leading to reduced narcotic need N o serious post-op complications
19 Prospective Randomized Trial Using dhacm in TKA One hundred patients for elective surgery 50/50 split with and without membrane usage Exclusion criteria include infection previous arthroplasty, severe medical morbidity
20 Technique Allograft membrane sewn above femoral component D eep to quad muscle All knees drained R outine PT protocols
21 Technique Continued:
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23 Conclusion Amniotic Tissue Allografts > Clinically Useful R educe cost with abundance of donor tissues E ase of handling Immunologically privileged biologic Potential efficacy for other orthopaedic purposes
24 Thank You
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