Knee Preservation and Articular Cartilage Restoration
|
|
- Brendan Dixon
- 5 years ago
- Views:
Transcription
1 Knee Preservation and Articular Cartilage Restoration With Special Thanks to Aaron Krych, MD and Riley Willims, MD Zak Knutson, MD Articular Cartilage Layer of tissue covering the bone which are part of a synovial joint Contains cells called chondrocytes which make the cartilage and surround themselves with it Cartilage functions as both a slick surface for motion and a compression surface for weight bearing cartilagediagram.jpg Articular Cartilage Cartilage has 4 zones which each function separately These layers can wear down like the tread on a tire or be taken off in large chunks from trauma Articular Cartilage CARTILAGE HAS A POOR INTRINSIC CAPACITY FOR REPAIR Many people have heard that cartilage doesn t grow back If you figure out how to do it let me know. We will make millions Articular Cartilage Injuries CLINICAL FACT ARTICULAR CARTILAGE LESIONS ARE FREQUENTLY ENCOUNTERED AJSM 2003 Articular Cartilage Injury in ~50% of athletes undergoing ACL reconstruction Often incidental findings during arthroscopy for other reasons OFTEN INCIDENTALLY FOUND CLINCAL PROBLEM 1
2 CM CM 43 Y.O. MALE KNEE PAIN ACHE 5+ YRS STEADILY INCREASING NO MECHANICAL SYMPTOMS LABORER FAILED PT & VISCOSUPPLEMENTATION LIMITED WALKING TOLERANCE MEDIALLY BASED PAIN TENDER MED JOINT LINE PAIN WITH HYPERFLEXION NO INSTABILITY NO EFFUSION ROM FULL LBS ALIGNMENT NEUTRAL CM CM WHAT IS THE BEST PROCEDURE FOR THIS PATIENT? HOW DOES ONE COME TO A DECISION? DILEMMA WHAT IS THE APPROPRIATE APPROACH TO ARTICULAR CARTILAGE SURGERY? CARTILAGE SURGERY WORKUP COMPONENTS What I need to make an Informed Decision HISTORY PHYSICAL EXAM RADIOGRAPHS MRI : CARTILAGE SENSITIVE PREVIOUS ARTHROSCOPY PHOTOS 2
3 CONSIDERATIONS THE LESION THE PATIENT THE KNEE THE SURGEON THE TIMING/REHAB THE EVIDENCE LESION ETIOLOGY TRAUMATIC CHRONIC DEGENERATIVE EARLY OA AVASCULAR NECROSIS OSTEOCHONDRITIS DISSECANS LESION CHARACTERISTICS LOCATION SIZE GRADE MORPHOLOGY CHARACTER CHONDRAL OSTEOCHONDRAL BONE LESION ONLY CONTAINMENT LESION CHARACTERISTICS Is there a critical size? 2 cm 2 lesions without degenerative changes at up to 4 years No difference in clinical outcome in ACL reconstructed knees with 2.1 cm 2 lesion vs control at 15 years Homminga et al JBJS 1990 Widuchowski et al AJSM 2009 MRI & Articular Cartilage Lesions Critical role Preoperative Planning Postoperative Assessment: Objective Previous MRI may not be good enough to see subtle changes in the cartilage PATIENT CHARACTERISTICS AGE DEMAND BODY MASS INDEX (BMI) / WEIGHT LOWER EXTREMITY ALIGNMENT FITNESS MENTAL STATE 3
4 PATIENT ISSUES: THE KNEE LEG ALIGNMENT MENISCI STABILITY MOTION PREVIOUS SURGERY OVERALL KNEE HEALTH UNDERSTANDING INDICATIONS SYMPTOMS PAIN RECURRENT EFFUSION MECHANICAL SYMPTOMS FOCAL CHONDRAL OR OSTEOCHONDRAL LESION OF THE KNEE INDICATIONS NORMAL OR CORRECTABLE KNEE ALIGNMENT NORMAL OR CORRECTABLE KNEE STABILITY MENISCI: FUNCTIONAL TISSUE KEYS TO SUCCESSFUL CARTILAGE REPAIR SURGERY LESION ETIOLOGY LESION CHARACTERISTICS PATIENT DEMAND PATIENT CHARACTERISTICS (BMI, ALIGNMENT) GOALS OF GIVEN SURGICAL REPAIR METHODS PHYSIOLOGY OF REPAIR METHODS AND ITS RELATION TO POSTOPERATIVE REHAB TECHNICAL ISSUES SURGEON RELATED ISSUES EXPERIENCE EXPERTISE KNOWN CARTILAGE REPAIR PROCEDURES OSTEOTOMY /Techniques PALLIATIVE INTRINSINC REPAIR ENHANCEMENT / MARROW STIM CELL BASED REPAIR WHOLE TISSUE TRANSPLANTATION SCAFFOLDS CELL + SCAFFOLDS PALLIATIVE The wash out REMOVAL MECHANICAL IRRITANTS STABILIZE CARTILAGE DEFECTS LESION FILL NOT ADDRESSED DEBRIDEMENT JOINT LAVAGE CHONDROPLASTY Temporary results, may not address primary issue 4
5 ENHANCEMENT OF INTRINSIC REPAIR / MARROW STIMULATION RECRUITMENT OF PLURIPOTENT MARROW BASED CELLS FOR PURPOSE OF FORMING REPAIR TISSUE MICROFRACTURE DRILLING ABRASION ARTHROPLASTY Bone Marrow Stimulation: Microfracture Most frequently used technique for treating small symptomatic lesions of the articular cartilage in the knee. Technically straightforward. Costs are low compared with other modalities. Can be used for surprise lesions JBJS (Am). 2010;92: Improvement of knee function scores was described in all studies during the first 24 months after microfracture. Decline of initial functional improvement after 2 years, although scores remain above preoperative levels. Repair Fill Excellent Fill Microfracture Magnetic Resonance Imaging Moderate Fill Poor Fill PRE-OPERATIVE 4 MONTHS POST MFX Micronized acellular cartilage Adjunct to microfracture Meant to form a scaffold and induce a more hyaline like repair Long term results pending In my current practice it is used in younger patients who heal better than adults 5
6 CELL BASED REPAIR IMPLANTATION OF EXPANDED or lab cultivated AUTOGENOUS CHONDROCYTES HYALINE LIKE CARTILAGE REQUIRES A COVER OR PATCH PERIOSTEUM or other absorbable matrix AUTOLOGOUS CHONDROCYTE IMPLANTATION (ACI) CARTICEL (GENZYME) CHONDROCELECT (TIGENIX) COLLAGEN COVERED AUTOLOGOUS CHONDROCYTE IMPLANTATION (CACI) MATRIX INDUCED AUTOLOGOUS CHONDROCYTE IMPLANTATION (MACI) ACI 1 Cartilage Harvest 2 Cartilage Growth 3 Excision of Bad Cartilage 4 Patch covering 5 Injection of good cells and SCOI.com Autologous chondrocyte implantation Development of hyaline-like cartilage, rather than fibrocartilage better long-term outcomes and longevity. Minimum of 2 operations. Technically demanding. Used in my practice for patellofemoral lesions Outcomes Brittberg et al, 1994: -14/16 patients with femoral condylar lesions had good to excellent results. Zaslav et al, 2009: -126 patients with failed prior treatments, 76% good clinical result. JBJS (Am). 2010;92: CELLS + SCAFFOLD This is the next step. Already in Europe IMPLANTATION OF AN MATRIX SCAFFOLD PRE SEEDED WITH AUTOGENOUS CHONDROCYTES TO INDUCE LESION FILL NEOCART (HISTOGENICS) MATRIX INDUCED AUTOLOGOUS CHONDROCYTE IMPLANTATION (MACI) GENZYME VERIGEN HYALOGRAFT C (FIDIA) WHOLE TISSUE TRANSPLANTATION IMPLANTATION OF A MATURE CARTILAGE plus BONE CONSTRUCT FOR PURPOSE OF RESURFACING A LESION WITH HYALINE CARTILAGE AUTOGRAFT MOSAICPLASTY OATS ALLOGRAFT FRESH FRESH FROZEN MINCED PEDIATRIC CARTILAGE Whole tissue transplantation: Osteochondral autografts or OATS Transplantation of viable hyaline cartilage from a different part of knee. Relatively brief rehabilitation period. Ability to perform in a single operation. Donor site morbidity. Limited availability of graft that can be harvested (patellofemoral joint or the zone adjacent to the intercondylar notch). Differences in orientation, thickness, and mechanical properties between donor and recipient cartilage. JBJS (Am). 2010;92:
7 MOSAICPLASTY or OATS TECHNIQUE MULTIPLE SMALL (< 10 mm) AUTOGRAFT OSTEOCHONDRAL PLUGS USED TO RESURFACE A CHONDRAL OR OSTEOCHONDRAL DEFECT ALLOGRAFT Cadaver or Donor Tissue Has been cleaned and prepared for implantation Can be bone, cartilage, or both Minced Cartilage DeNovo NT Natural Tissue Graft Juvenile donor cartilage Has ability to grow Single stage procedure with graft help in place by fibrin glue No long term results No filling of bony defects Whole tissue transplantation: Osteochondral allografts Precise surface architecture. Single-stage procedure. Potential to replace large defects. No donor site morbidity. Limited graft availability. High cost. Risk of immunological rejection. Possible incomplete incorporation. Potential for disease transmission. JBJS (Am). 2010;92:
8 OSTECHONDRAL ALLOGRAFTS FRESH GRAFTS = VIABLE CELLS THEORY = LAST INDEFINITELY TREATMENT RATIONALE RESURFACE INCONGRUENT JOINT WITH SIZE MATCHED WHOLE TISSUE ALLOGRAFT CONTAINING VIABLE CELLS INDICATIONS LARGE LESIONS CM 2 BONE LOSS OR INVOLVEMENT NONCONSTRAINED LESIONS OCD, AVN PATELLA, TIBIA, FEMUR OK SALVAGE FOR FAILED FIRST LINE TXs Below the Bar Techniques Non cell based techniques Did not require the approval process of the viable cell implantation techniques Generally cheaper Can be stored on the shelf SCAFFOLD BASED REPAIR IMPLANTATION OF A SYNTHETIC SCAFFOLD MATRIX TO FACILITATE ARTICULAR CARTILAGE GROWTH & LESION RESURFACING SYNTHETIC BIPHASIC ABSORBABLE TRUFIT (SMITH & NEPHEW) OSSEOFIT (BIOMET) Chondrofix Osteochondral Allograft Acellular Donor Cartilage and Bone May serve to remove painful diseased subchondral bone How long does it last? TruFit CB Plug Maturation Has been PULLED FROM THE MARKET Longer follow-up ( 16 months) favorable 70% of plugs flush morphology 90% of plugs complete defect fill Excellent subchondral osseous incorporation 6 months 12 months 25 months 8
9 Current Treatment Options for Articular Cartilage Repair in the U.S. TREATMENT REPAIR TISSUE FILL DURABILITY CHONDROPLASTY None None Poor ENHANCEMENT INTRINSIC REPAIR Fibrocartilage Partial 2-11 Years AUTOLOGOUS OSTEOCHONDRAL TRANSPLANTATION CELL BASED Hyaline Cartilage Near Total 2-10 Years Hyaline Like Fibrocartilage Partial 2-11 Years SCAFFOLD BASED Hyaline Like Near Total 1-2 Years Cartilage Repair Methods Clinical Applications of Cartilage Repair Methodologies Osteochondral Allograft Autologous Chondrocyte Implantation Osteochondral Autograft Marrow Stimulating Technique CELL + SCAFFOLD Hyaline Like Near Total 2-3 Years ALLOGRAFT OSTEOCHONDRAL TRANSPLANTATION Hyaline Cartilage Near Total 5-15 Years Debridement / Lavage Lesion Size (CM ) Surgical Treatment Options for the Management of Symptomatic Focal Cartilage Lesions of the Femur: U.S. LESION SIZE < 2 CM 2 Surgical Treatment Options for the Management of Symptomatic Focal Cartilage Lesions of the Femur: U.S. LESION SIZE >2 CM 2 PRIMARY TREATMENT SECONDARY TREATMENT PRIMARY TREATMENT SECONDARY TREATMENT LOW DEMAND HIGH DEMAND HIGH OR LOW DEMAND LOW DEMAND HIGH DEMAND HIGH OR LOW DEMAND 1.Palliative 2.Enhancement Intrinsic Repair 3. Scaffolds 1. Enhancement Intrinsic Repair 2.Osteochondral Autograft 3.Osteochondral Allograft 4.Cell Based Repair 5.Cell Based + Scaffold 1.Osteochondral Autograft 2.Osteochondral Allograft 3.Cell Based Repair 4.Scaffold Based Repair 5.Cell + Scaffold Repair 1.Palliative 2.Enhancement Intrinsic Repair 3.Osteochondral Autograft 4.Osteochondral Allograft 5.Cell Based Repair 1.Enhancement Intrinsic Repair 2.Osteochondral Autograft 3.Osteochondral Allograft 4.Cell Based Repair 5.Cell Based + Scaffold 1.Osteochondral Autograft 2.Osteochondral Allograft 3.Cell Based Repair 4.Cell Based + Scaffold Williams & Brophy Instr Course Lec : Williams & Brophy Instr Course Lec : KEYS TO SUCCESSFUL CARTILAGE REPAIR SURGERY LESION ETIOLOGY LESION CHARACTERISTICS PATIENT DEMAND PATIENT CHARACTERISTICS (BMI, ALIGNMENT) GOALS OF GIVEN SURGICAL REPAIR METHODS PHYSIOLOGY OF REPAIR METHODS AND ITS RELATION TO POSTOPERATIVE REHAB TECHNICAL ISSUES Rehab, Rehab,Rehab!!!!!!! Most repairs/implantations are 6 weeks of non or TTWB All will use CPM for that time Cartilage loves motion! Generally, low impact sports such as swimming, skating, in line skating, and cycling are permitted at about 6 months. High impact sports such as jogging, running, and aerobics may be performed at 8 9 months for small lesions 9 12 months for larger lesions. High impact pivoting sports such as tennis, basketball, football, and baseball may be allowed at months. 9
10 Concomitant Procedures Improve success rate Osteotomy Distal Femur, DFO Proximal Tibia, HTO Tibial Tubercle Ligament Reconstruction Meniscal Transplant Prior meniscectomy Patient Expectations/Rehab One year recovery, rehab. May be months before return to high impact sports Sooner for lower impact and smaller lesions Trying to get rid of daily pain not improve your marathon time Commitment on both of our parts NO! Arthritis Lesions in Multiple places Bone loss RA Gout/Pseudogou t A Lot to Ask Thank You 10
11 Zak Knutson, MD Please call or me any time
OSTEOCHONDRAL ALLOGRAFT RECONSTRUCTION FOR MASSIVE BONE DEFECT
OSTEOCHONDRAL ALLOGRAFT RECONSTRUCTION FOR MASSIVE BONE DEFECT Angelo J. Colosimo, MD -Head Orthopaedic Surgeon University of Cincinnati Athletics -Director of Sports Medicine University of Cincinnati
More informationChondral Injuries in the Athlete
Chondral Injuries in the Athlete Michael J. Stuart MD Professor of Orthopedic Surgery Chair, Division of Sports Medicine Mayo Clinic 2013 MFMER slide-1 Michael J. Stuart MD February 5, 2014 Financial Relationships
More informationTREATMENT OF CARTILAGE LESIONS
TREATMENT OF CARTILAGE LESIONS Angelo J. Colosimo, MD -Head Orthopaedic Surgeon University of Cincinnati Athletics -Director of Sports Medicine University of Cincinnati Medical Center -Associate Professor
More informationOSTEOCHONDRAL ALLOGRAFTS AND AUTOGRAFTS IN THE TREATMENT OF FOCAL ARTICULAR CARTILAGE LESIONS
Status Active Medical and Behavioral Health Policy Section: Surgery Policy Number: IV-115 Effective Date: 10/22/2014 Blue Cross and Blue Shield of Minnesota medical policies do not imply that members should
More informationBasics of Cartilage Restoration Introduction of TruFit
Basics of Cartilage Restoration Introduction of TruFit Philip A. Davidson, MD Heiden Orthopaedics Park City, Utah USA Smith & Nephew Seminar London, UK October 2008 Cartilage Restoration A wide realm between..
More informationArticular Cartilage Surgical Restoration Options
Articular Cartilage Surgical Restoration Options Randy Schwartzberg, M.D. Assistant Professor - UCF College of Medicine Rationale Our bodies do not make articular/hyaline cartilage. gics injections to
More informationCorporate Medical Policy
Corporate Medical Policy Autologous Chondrocyte Implantation File Name: Origination: Last CAP Review: Next CAP Review: Last Review: autologous_chondrocyte_implantation 4/1996 6/2017 6/2018 6/2017 Description
More informationIdeal Candidate for Cartilage Restoration. Large or Complex Lesions
Complex Biological Knee Reconstruction: Bipolar, Multifocal Lesions and Osteoarthritis William Bugbee, MD Attending Physician, Scripps Clinic 18 th International Sports Medicine Fellow s Conference Ideal
More informationAUTOLOGOUS CHONDROCYTE IMPLANTATION FOR FOCAL ARTICULAR CARTILAGE LESIONS
CARTILAGE LESIONS Non-Discrimination Statement and Multi-Language Interpreter Services information are located at the end of this document. Coverage for services, procedures, medical devices and drugs
More informationRakesh Patel, MD 4/9/09
Rakesh Patel, MD 4/9/09 Chondral Injuries Very common Present in 63-66% patients undergoing arthroscopy 11-19% full-thickness lesions Up to 79% patients with ACL deficient knee have some form of chondral
More informationAutografts and Allografts in the Treatment of Focal Articular Cartilage Lesions
Autografts and Allografts in the Treatment of Focal Articular Cartilage Lesions Policy Number: 7.01.78 Last Review: 2/2018 Origination: 8/2002 Next Review: 2/2019 Policy Blue Cross and Blue Shield of Kansas
More informationCartilage Repair Options
Imaging of Cartilage Repair Carl S. Winalski, MD Imaging Institute Department of Biomedical Engineering Cleveland Clinic Cartilage Repair Options Direct repair Marrow stimulation Autologous transplantation
More informationThe Aging Athletes Knee
The Aging Athletes Knee Douglas P Tewes Orthopedic Sports Medicine Lincoln Orthopedic Center 1 Common Sports Knee Injuries Cartilage defects/chondromalacia Meniscal tears ACL tear Articular Cartilage injury/chondromalacia
More informationDisclosures. How to approach cartilage repair. Articular Cartilage Problems: Surface Options
Disclosures I have the following potential conflicts of interest: Consulting payments/royalties and research support directly related to products discussed: Vericel (ACI) [consultant] SLACK publishing
More informationOsteochondral Allograft Transplantation and Autograft Transfer System (OATS/mosaicplasty) in the Treatment of Articular
Osteochondral Allograft Transplantation and Autograft Transfer System (OATS/mosaicplasty) in the Treatment of Articular Cartilage Lesions Corporate Medical Policy File name: Osteochondral Allograft Transplantation
More informationPATIENT GUIDE TO CARTILAGE INJURIES
Lucas Wymore, MD Sports Medicine 23000 Moakley Street Suite 102 Leonardtown MD 20650 Office Phone: 301-475-5555 Office Fax: 301-475- 5914 Email: lwymore@somdortho.com PATIENT GUIDE TO CARTILAGE INJURIES
More informationAutologous Chondrocyte Implantation and Other Cell-based Treatments of Focal Articular Cartilage Lesions. Original Policy Date
MP 7.01.36 Autologous Chondrocyte Implantation and Other Cell-based Treatments of Focal Articular Cartilage Lesions Medical Policy Section Surgery Issue 12:2013 Original Policy Date 12:2013 Last Review
More informationARTICULAR CARTILAGE RESTORATION: A REVIEW OF CURRENTLY AVAILABLE METHODS FOR REPAIR OF ARTICULAR CARTILAGE DEFECTS
ARTICULAR CARTILAGE RESTORATION: A REVIEW OF CURRENTLY AVAILABLE METHODS FOR REPAIR OF ARTICULAR CARTILAGE DEFECTS AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS 76TH ANNUAL MEETING FEBRUARY 25-28, 2009 LAS
More information3/13/2018. Cartilage Cases. Case. Physical exam
Cartilage Cases Aaron J. Krych, MD Professor, Orthopedic Surgery Sports Medicine Fellowship Director Sports Medicine Research Fellowship Director Mayo Clinic 2014 MFMER slide-1 Case 19 yo F division I
More informationOsteochondritis Dissecans of the Knee. M Lucas Murnaghan MD, MEd, FRCSC
Osteochondritis Dissecans of the Knee M Lucas Murnaghan MD, MEd, FRCSC Outline 1. Clinical Presentation 2. Investigations 3. Classification 4. Non-operative Treatment 5. Operative Treatment 6. Treatment
More informationAutologous Chondrocyte Implantation. Gerard Hardisty FRACS
Autologous Chondrocyte Implantation Gerard Hardisty FRACS Disclosure Orthopaedic Surgeons Strong as an OX and half as bright Orthopaedic Innovation Arthroscopy Joint replacement Trauma management MIS Early
More informationPage: 1 of 21. Autologous Chondrocyte Implantation for Focal Articular Cartilage Lesions
Page: 1 of 21 Last Review Status/Date: September 2015 Focal Articular Cartilage Lesions Description A variety of procedures are being developed to resurface articular cartilage defects. Autologous chondrocyte
More informationACI < > < > +/- MSC MSC MASS
Articular Cartilage Injury Natural History Management of Small Articular Cartilage Lesions Kai Mithoefer, MD Harvard Vanguard Medical Associates Harvard Medical School New England Baptist Hospital Boston,
More informationRehabilitation Protocol:
Rehabilitation Protocol: Patellofemoral resurfacing: Osteochondral Autograft Transplantation (OATS), Autologous Chondrocyte Implantation (ACI) and Microfracture Department of Orthopaedic Surgery Lahey
More informationCARTILAGE LESIONS IN THE PATELLOFEMORAL JOINT
GENERAL OVERVIEW CARTILAGE LESIONS IN THE PATELLOFEMORAL JOINT Written by Mats Brittberg, Sweden The general low level of understanding of problems in the patellofemoral joint is reflected in the large
More informationAutologous Chondrocyte Implantation for Focal Articular Cartilage Lesions
Autologous Chondrocyte Implantation for Focal Articular Cartilage Lesions Applies to all products administered or underwritten by Blue Cross and Blue Shield of Louisiana and its subsidiary, HMO Louisiana,
More informationDoes Every Knee Need a Meniscus?
Transcript Details This is a transcript of an educational program accessible on the ReachMD network. Details about the program and additional media formats for the program are accessible by visiting: https://reachmd.com/programs/clinicians-roundtable/does-every-knee-need-a-meniscus/3799/
More informationPOLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT VARIATIONS DISCLAIMER CODING INFORMATION REFERENCES POLICY HISTORY
Original Issue Date (Created): July 1, 2002 Most Recent Review Date (Revised): January 28, 2014 Effective Date: April 1, 2014 POLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT
More informationJoint Preservation Clinical Case
Joint Preservation Clinical Case Jason M. Scopp, M.D. Director of Joint Preservation Peninsula Orthopaedic Associates, 1/19/19 Rational Rationale There are no absolutes. There is no dogma. Organize thoughts,
More informationOsteochondral Problems of the Knee
Arthroscopy: The Journal of Arthroscopic & Related Surgery Online October 1999, Supplement 1 Volume 15 Number 7
More informationAnterior Cruciate Ligament (ACL) Injuries
Anterior Cruciate Ligament (ACL) Injuries Mark L. Wood, MD The anterior cruciate ligament (ACL) is one of the most commonly injured ligaments of the knee. The incidence of ACL injuries is currently estimated
More informationMarrow (MSC) Stimulation Techniques: Microfracture/Microfracture Plus/Cartiform Kai Mithoefer, MD
Marrow (MSC) Stimulation Techniques: Microfracture/Microfracture Plus/Cartiform Kai Mithoefer, MD Harvard Vanguard Medical Associates New England Baptist Hospital Boston, USA Cartilage Repair Marrow Stimulation
More informationMedical Policy An independent licensee of the Blue Cross Blue Shield Association
Autografts and Allografts in the Treatment of Focal Page 1 of 30 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Autografts and Allografts in the Treatment of Focal
More informationMedical Policy An independent licensee of the Blue Cross Blue Shield Association
Autologous Chondrocyte Implantation for Focal Articular Cartilage Lesions Page 1 of 19 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Autologous Chondrocyte Implantation
More informationHorizon Scanning Centre November Spheroids of human autologous matrix-associated chondrocytes (Chondrosphere) for articular cartilage defects
Horizon Scanning Centre November 2014 Spheroids of human autologous matrix-associated chondrocytes (Chondrosphere) for articular cartilage defects SUMMARY NIHR HSC ID: 8515 This briefing is based on information
More informationCase Report. Byung Ill Lee, MD and Byoung Min Kim, MD Department of Orthopedic Surgery, Soonchunhyang University Hospital, Seoul, Korea
Case Report Knee Surg Relat Res 2015;27(4):263-268 http://dx.doi.org/10.5792/ksrr.2015.27.4.263 pissn 2234-0726 eissn 2234-2451 Knee Surgery & Related Research Concomitant Osteochondral utograft Transplantation
More informationBASELINE QUESTIONNAIRE (SURGEON)
SECTION A: STUDY INFORMATION Subject ID: - - Study Visit: Baseline Site Number: Date: / / Surgeon ID: SECTION B: INITIAL SURGEON HISTORY B1. Previous Knee Surgery: Yes No Not recorded B2. Number of Previous
More informationIntroduction Knee Anatomy and Function Making the Diagnosis
Introduction Knee injuries are a very common problem among active individuals. It is important for us to understand how your knee was injured. Most knee injuries are associated with non-contact mechanisms.
More informationOsteo-chondral Transplantation (OATS) The Unhappy ACL. Dr Ivan Popoff Knee, Elbow & Shoulder Surgery
Osteo-chondral Transplantation (OATS) The Unhappy ACL The Unhappy ACL ACL reconstruction highly successful surgery for restoring stability and return to pre-injury levels of sporting activity? Return to
More informationOCD: Beyond Microfracture. Disclosures. OCD Talus: My Approach 2/23/2018
OCD: Beyond Microfracture Gregory C Berlet MD, FRCS(C), FAOA Orthopedic Foot and Ankle Center Columbus Ohio Disclosures Consultant/Speaker Bureau/Royalties/ Stock: Wright Medical, Stryker, ZimmerBiomet,
More informationOsteochondral allografting for all other joints is not covered as the evidence is insufficient to determine the
Medical Coverage Policy Osteochondral Autologous Chrondrocyte Implantation for Focal Articular Cartilage Lesions EFFECTIVE DATE: 05 20 2008 POLICY LAST UPDATED: 10 16 2018 OVERVIEW A variety of procedures
More informationCARTILAGE REPAIR INTRODUCTION. M. BERRUTO and G.M. PERETTI 1,2. Received January 6, Accepted January 8, 2013
CARTILAGE REPAIR INTRODUCTION M. BERRUTO and G.M. PERETTI 1,2 Gaetano Pini Orthopedic Institute, Milan; 1 Department of Biomedical Sciences for Health, University of Milan, 2 IRCCS Galeazzi Orthopedic
More informationCARTILAGE REPAIR PROCEDURES IN LARGE CARTILAGE DEFECTS
CARTILAGE REPAIR TECHNIQUES CARTILAGE REPAIR PROCEDURES IN LARGE CARTILAGE DEFECTS Written by Steffano Zaffagnini, Francesco Perdisa and Giuseppe Filardo, Italy Knee articular cartilage defects greater
More informationAN OVERVIEW : Cartilage Treatment. Eric Thiel, MD. WVAM Conference 01/25/2019
AN OVERVIEW : Cartilage Treatment Eric Thiel, MD WVAM Conference 01/25/2019 No Disclosure The Science of Hyaline Cartilage I. HYALINE CARTILAGE BASIC SCIENCE Normal Anatomy Cartilage is hypocellular, avascular,
More informationARTICULAR CARTILAGE INJURY: EVALUATION AND WORK-UP ISMF Carlsbad Ca.
ARTICULAR CARTILAGE INJURY: EVALUATION AND WORK-UP IMF 2018- Carlsbad Ca. Ken Zaslav MD Director: Cartilage Restoration Center ORTHO VIRGINIA: Richmond Virginia Clinical Prof. of Orthopedic urgery: V.C.U.
More informationSt Vincent s SportsMed
St Vincent s SportsMed Cartilage Transplantation In The Knee INTRODUCTION Normal articular cartilage is characterized by a smooth surface with very low friction and the ability to withstand repeated high
More informationOsteochondral Knee Injuries. Marc N Ialenti, MD PGY-4 8/19/14
Osteochondral Knee Injuries Marc N Ialenti, MD PGY-4 8/19/14 Articular Cartilage Complex, layered structure Viscoelastic material Resist shear forces Variable loadbearing Range of motion Position Essential
More informationSpecialists in Joint Replacement, Spinal Surgery, Orthopaedics and Sport Injuries. Cartilage Surgery. The Knee.
Specialists in Joint Replacement, Spinal Surgery, Orthopaedics and Sport Injuries Cartilage Surgery The Knee CARTILAGE INJURY Treatment of cartilage injury remains one of the most significant challenges
More informationMEDICAL POLICY SUBJECT: OSTEOCHONDRAL GRAFTING
MEDICAL POLICY PAGE: 1 OF: 7 If the member's subscriber contract excludes coverage for a specific service it is not covered under that contract. In such cases, medical policy criteria are not applied.
More informationRehabilitation Protocol: Distal Femoral/Proximal Tibial Microfracture and Osteochondral Autograft Transplantation (OATS)
Rehabilitation Protocol: Distal Femoral/Proximal Tibial Microfracture and Osteochondral Autograft Transplantation (OATS) Department of Orthopaedic Surgery Lahey Hospital & Medical Center, Burlington 781-744-8650
More informationOverview of Multiple Cartilage Sparing Techniques and Rehab Principles For The Knee
Overview of Multiple Cartilage Sparing Techniques and Rehab Principles For The Knee Owner & Founder of the Fischer Institute www.fischerinstitute.com Trent Rincon, PT, MPT, CSCS Brett Fischer PT, ATC,
More informationNo Disclosures. Topics. Pediatric ACL Tears
Knee Injuries in Skeletally Immature Athletes No Disclosures Zachary Stinson, M.D. 2 Topics ACL Tears and Tibial Eminence Fractures Meniscus Injuries Discoid Meniscus Osteochondritis Dessicans Patellar
More informationTreatment of Full-Thickness Chondral Defects in the Knee With Autologous Chondrocyte Implantation
Treatment of Full-Thickness Chondral Defects in the Knee With Autologous Chondrocyte Implantation Scott D. Gillogly, MD 1 Thomas H. Myers, MD 2 Michael M. Reinold, PT, DPT, ATC, CSCS 3 Autologous chondrocyte
More informationAUTOLOGOUS CHONDROCYTE IMPLANTATION FOR CHONDRAL KNEE DAMAGE B.A. Jalba 1, C.S. Jalba 2, F. Gherghina 3, M. Cruce 3
AUTOLOGOUS CHONDROCYTE IMPLANTATION FOR CHONDRAL KNEE DAMAGE B.A. Jalba 1, C.S. Jalba 2, F. Gherghina 3, M. Cruce 3 1-EMERGENCY CLINICAL HOSPITAL FLOREASCA BUCHAREST 2-EMERGENCY CLINICAL HOSPITAL SFANTUL
More informationOsteochondral Autografts and Allografts in the Treatment of Focal Articular Cartilage Lesions. Original Policy Date
MP 7.01.61 Osteochondral Autografts and Allografts in the Treatment of Focal Articular Cartilage Lesions Medical Policy Section Surgery Issue 12/2013 Original Policy Date 12/2013 Last Review Status/Date
More informationevicore MSK joint surgery procedures requiring prior authorization
evicore MSK joint surgery procedures requiring prior authorization Moda Health Commercial Group and Individual Members* Updated 1/30/2018 *Check EBT to verify member enrollment in evicore program Radiology
More information5:05 6:05 pm Live Surgery: office based Arthroscopy (Trice Medical) (1 hr) Surgeon: Sean McMillan, DO Moderator: Chris Uggen, MD
AAOS Articular Cartilage Restoration: Current, Emerging, and Advanced Techniques Course # 3252 February 7-9, 2019 OLC Education and Conference Center, Rosemont, IL Course Directors: Kevin D. Plancher,
More informationFirst Metatarsal Head Osteochondral Defect Treatment with Particulated Juvenile Cartilage Allograft Transplantation
First Metatarsal Head Osteochondral Defect Treatment with Particulated Juvenile Cartilage Allograft Transplantation Bryan Van Dyke, DO Gregory C. Berlet, MD Justin L. Daigre, MD Christopher F. Hyer, DPM,
More informationGreetings From SCOI. Richard D. Ferkel, M.D
Greetings From SCOI Richard D. Ferkel, M.D OLT In the Athlete Operative Treatment and Return to Play The Following relationships exist: Royalties and stock options Smith and Nephew Consulting income
More informationKnee Cartilage Transplants
Knee Cartilage Transplants Date of Origin: 3/2005 Last Review Date: 8/23/2017 Effective Date: 8/23/2017 Dates Reviewed: Developed By: Medical Necessity Criteria Committee I. Description Allograft transplants
More informationKnee Articular Cartilage Restoration: From cells to the patient. Professor Lars Engebretsen, University of Oslo, Norway
Knee Articular Cartilage Restoration: From cells to the patient Professor Lars Engebretsen, University of Oslo, Norway Much of this started in 1994: I 1989 Grande et al -cartilage cell transplantation
More informationCartilage Injuries of the Knee. Jason Hurbanek MD Hinsdale Orthopaedic Associates WCLA Spring Medical Forum April 12 th, 2019
Cartilage Injuries of the Knee Jason Hurbanek MD Hinsdale Orthopaedic Associates WCLA Spring Medical Forum April 12 th, 2019 1 Disclosures I have nothing to disclose related to this presentation. 2 Introduction
More information40 th Annual Symposium on Sports Medicine. Knee Injuries In The Pediatric Athlete. Disclosure
40 th Annual Symposium on Sports Medicine Travis Murray, MD Assistant Professor University of Texas Health Science Center San Antonio Knee Injuries In The Pediatric Athlete Disclosure Dr. Travis Murray
More informationOsteoarthritis. Dr Anthony Feher. With special thanks to Dr. Tim Williams and Dr. Bhatia for allowing me to use some of their slides
Osteoarthritis Dr Anthony Feher With special thanks to Dr. Tim Williams and Dr. Bhatia for allowing me to use some of their slides No Financial Disclosures Number one chronic disability in the United States
More informationLife. Uncompromised. The KineSpring Knee Implant System Surgeon Handout
Life Uncompromised The KineSpring Knee Implant System Surgeon Handout 2 Patient Selection Criteria Patient Selection Criteria Medial compartment degeneration must be confirmed radiographically or arthroscopically
More informationOsteochondritis Dissecans
Osteochondritis Dissecans Introduction Osteochondritis dissecans (OCD) is a problem that affects the knee, mostly at the end of the big bone of the thigh (the femur). A joint surface damaged by OCD doesn't
More informationFailed Cartilage Repair
Chapter 27 Failed Cartilage Repair Robert C. Grumet, Sarvottam Bajaj, and Brian J. Cole The management of traumatic and degenerative cartilage lesions is a known challenge given the limited vascularity
More information42 nd Annual Symposium on Sports Medicine. Knee Injuries In The Pediatric Athlete. Disclosure
42 nd Annual Symposium on Sports Medicine Travis Murray, MD Assistant Professor University of Texas Health Science Center San Antonio January 23, 2015 Knee Injuries In The Pediatric Athlete Disclosure
More informationMSK Covered Services. Musculoskeletal: Joint Metal-on-metal total hip resurfacing, including acetabular and femoral components
CPT CODE S2118 MSK Covered Services Musculoskeletal: Joint Metal-on-metal total hip resurfacing, including acetabular and femoral components 23000 Removal of subdeltoid calcareous deposits, open 23020
More informationACL Athletic Career. ACL Rupture - Warning Features Intensive pain Immediate swelling Locking Feel a Pop Dead leg Cannot continue to play
FIMS Ambassador Tour to Eastern Europe, 2004 Belgrade, Serbia Montenegro Acute Knee Injuries - Controversies and Challenges Professor KM Chan OBE, JP President of FIMS Belgrade ACL Athletic Career ACL
More informationTransformational Products in Soft Tissue Regeneration and Cartilage Repair
Transformational Products in Soft Tissue Regeneration and Cartilage Repair Company History Founded in 2000 Late stage clinical company Privately held, based in Waltham, MA 42 Employees Acquisition of ProChon
More informationMeniscal Tears/Deficiency in Athletes
Meniscal Tears/Deficiency in Athletes A. Amendola MD Professor of Orthopaedic Surgery Director of Sports Medicine Duke University 1 2 Meniscal tears Introduction Meniscal tears are one of the most frequent
More informationAutologous Chondrocyte Implantation for Focal Articular Cartilage Lesions
Autologous Chondrocyte Implantation for Focal Articular Cartilage Lesions Policy Number: Original Effective Date: MM.06.002 8/1/2009 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST 12/01/2017
More informationCartilage Care in the Mature Female Athlete
Cartilage Care in the Mature Female Athlete K. Linnea Welton, MD Hip Preservation Fellow Department of Orthopedic Surgery University of Colorado Women in Sports Medicine Conference February 24, 2018 Disclosures
More informationNew Directions in Osteoarthritis Research
New Directions in Osteoarthritis Research Kananaskis October 22, 2015 Nick Mohtadi MD MSc FRCSC No conflicts of interest related to this presentation 1 Osteoarthritis: Disease? Fact of Life? Strong family
More information8/10/2016. Treatment of Articular Cartilage Injuries: Osteochondral autograft Osteochondral allograft DISCLOSURES CONSIDERATIONS:
Treatment of Articular Cartilage Injuries: Center for Cartilage Repair and Restoration University of Kentucky Osteochondral autograft Osteochondral allograft Christian Lattermann, MD Professor for Orthopaedics
More informationKNEE INJURIES IN SPORTS MEDICINE
KNEE INJURIES IN SPORTS MEDICINE Irving Raphael, MD June 13, 2014 RSM Medical Associates Head Team Physician Syracuse University Outline Meniscal Injuries anatomy Exam Treatment ACL Injuries Etiology Physical
More informationCartilage repair update: Indications are being refined and the future is bright
Cartilage repair update: Indications are being refined and the future is bright ORTHOPEDICS TODAY 2008; 28:46 September 2008 Cartilage is a highly structured tissue with low cellularity and virtually no
More informationEvaluation & Treatment of the Injured Athlete Autograft OATS versus Osteochondral Allograft Technique: Indications, Problems, Outcomes
Evaluation & Treatment of the Injured Athlete Autograft OATS versus Osteochondral Allograft Technique: Indications, Problems, Outcomes C H R I S T I A N L AT T E R M A N N C H I E F O F S P O R T S M E
More informationFresh Osteochondral Allograft Reimbursement Reference Document
Fresh Osteochondral Allograft Reimbursement Reference Document This information is provided as a coding guide based on the experiences of clinicians with whom we have worked with over the years, and is
More informationDisclosures 8/11/2017. ACI 2 Stage Technique Generation 1. Technical Improvements and Expansion of Indications based on evidence for ACI
Technical Improvements and Expansion of Indications based on evidence for ACI Tom Minas MD MS Director, Cartilage Repair Center, Brigham and Women s, Hospital, Professor, Harvard Medical School, Boston
More informationMid-Term Clinical Outcomes of Atelocollagenassociated Autologous Chondrocyte Implantation for the Repair of Chondral Defects of the Knee
International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine Cancun, Mexico MAY 12 16, 2019 Mid-Term Clinical Outcomes of Atelocollagenassociated Autologous Chondrocyte Implantation
More informationTheoretical Background Cartilage
Theoretical Background Cartilage NEW TECHNIQUES FOR CARTILAGE REPAIR AND REPLACEMENT Kevin R. Stone, M.D. Michael J. Mullin, ATC, PTA Injury to the cartilage of the knee joint is one of the most common
More informationHistologic change of cartilage layer of osteochondritis dissecans before and after fixation in the knee
1 Histologic change of cartilage layer of osteochondritis dissecans before and after fixation in the knee Mitsuo Ochi, M.D. PhD Professor and chairman Department of Orthopaedic Surgery Graduate School
More informationOSTEOCHONDRAL GRAFTING OF KNEE
MEDICAL POLICY OSTEOCHONDRAL GRAFTING OF KNEE Policy Number: 2013T0537D Effective Date: November 1, 2013 Table of Contents COVERAGE RATIONALE... BACKGROUND... CLINICAL EVIDENCE... U.S. FOOD AND DRUG ADMINISTRATION...
More information7 Advanced Course on Knee Surgery. 14 to 18 January 2018 Val d Isère France. Classification of the cartilage lesions.
7 Advanced Course on Knee Surgery TH Centre of Orthopeadics and Traumatology Hospital Brandenburg th th Fontane Medical School Theodor 14 to 18 January 2018 Val d Isère France Classification of the cartilage
More informationCase Report Arthroscopic Microfracture Technique for Cartilage Damage to the Lateral Condyle of the Tibia
Case Reports in Orthopedics Volume 2015, Article ID 795759, 5 pages http://dx.doi.org/10.1155/2015/795759 Case Report Arthroscopic Microfracture Technique for Cartilage Damage to the Lateral Condyle of
More informationAnterior Cruciate Ligament Surgery
Anatomy Anterior Cruciate Ligament Surgery Roger Ostrander, MD Andrews Institute Anatomy Anatomy Function Primary restraint to anterior tibial translation Secondary restraint to internal tibial rotation
More informationNovel Techniques in Articular Cartilage Restoration
21 Novel Techniques in Articular Cartilage Restoration Adam B. Yanke, MD and Brian J. Cole, MD, MBA PART ONE: DENOVO NT Introduction DeNovo NT (Zimmer) is minced (1-mm cubes) juvenile allograft cartilage
More informationIKDC DEMOGRAPHIC FORM
IKDC DEMOGRAPHIC FORM Your Full Name Your Date of Birth / / Your Social Security Number - - Your Gender: Male Female Occupation Today s Date / / The following is a list of common health problems. Please
More informationBAD RESULTS OF CONSERVATIVE TREATMENT OF ACL TEARS IN CHILDREN. Guy BELLIER PARIS France
BAD RESULTS OF CONSERVATIVE TREATMENT OF ACL TEARS IN CHILDREN Guy BELLIER PARIS France TREATMENT OF ACL TEARS IN CHILDREN CONTROVERSIAL DIAGNOSIS clinical exam X-rays (stress) M.R.I. arthroscopy ACL TEARS
More informationMedical Practice for Sports Injuries and Disorders of the Knee
Sports-Related Injuries and Disorders Medical Practice for Sports Injuries and Disorders of the Knee JMAJ 48(1): 20 24, 2005 Hirotsugu MURATSU*, Masahiro KUROSAKA**, Tetsuji YAMAMOTO***, and Shinichi YOSHIDA****
More informationHip, Knee and Shoulder Surgery
Hip, Knee and Shoulder Surgery Policy Number: MM.06.030 Lines of Business: HMO; PPO; QUEST Integration; Medicare Advantage Section: Surgery Place(s) of Service: Outpatient; Inpatient Original Effective
More informationIndex. D Delayed gadolinium-enhanced MRI of cartilage (dgemric), 357,
A ACI. See Autologous chondrocyte implantation (ACI) Anaesthesia carbon dioxide arthroscopy, 352 high tibial osteotomy, 273 injection, 350 knee surgery, 350 regional anaesthesia ambulatory surgery, spinal,
More informationClinical Policy Title: Autologous chondrocyte implantation
Clinical Policy Title: Autologous chondrocyte implantation Clinical Policy Number: 14.03.07 Effective Date: March 1, 2017 Initial Review Date: February 15, 2017 Most Recent Review Date: February 6, 2018
More informationOsteochondral Grafting
Last Review Date: January 19, 2017 Number: MG.MM.SU.68 Medical Guideline Disclaimer Property of EmblemHealth. All rights reserved. The treating physician or primary care provider must submit to EmblemHealth
More informationWhy do they fail?? TOM MINAS MD MS. The Management of Failed Cartilage Repair Procedures PALM BEACH FL
The Management of Failed Cartilage Repair Procedures Why do they fail?? TOM MINAS MD MS DIRECTOR, CARTILAGE REPAIR CENTER, PALEY ORTHOPEDIC INSTITUTE, PALM BEACH FL PROFESSOR EMERITUS, HARVARD MEDICAL
More informationA Patient s Guide to Osteochondritis Dissecans of the Knee
A Patient s Guide to Osteochondritis Dissecans of the Knee 2350 Royal Boulevard Suite 200 Elgin, IL 60123 Phone: 847.931.5300 Fax: 847.931.9072 DISCLAIMER: The information in this booklet is compiled from
More informationTHE DIAGNOSIS AND MANAGEMENT OF SPONTANEOUS AND POST-ARTHROSCOPY OSTEONECROSIS OF THE KNEE
THE DIAGNOSIS AND MANAGEMENT OF SPONTANEOUS AND POST-ARTHROSCOPY OSTEONECROSIS OF THE KNEE Abstract Spontaneous osteonecrosis of the knee (SPONK) and osteonecrosis in the postoperative knee (ONPK) are
More informationMedial Meniscal Root Tears: When to rehab? When to repair? When to debride. Christopher Betz, DO Orthopedics Sports Medicine Bristol, CT
Medial Meniscal Root Tears: When to rehab? When to repair? When to debride Christopher Betz, DO Orthopedics Sports Medicine Bristol, CT Disclosure Consultant Mitek Smith and Nephew-biologic patch Good
More information