Arthroscopic fixation of chondrotissue: Preclinical and biomechanical data. Wolf Petersen

Transcription

1 Arthroscopic fixation of chondrotissue: Preclinical and biomechanical data Wolf Petersen Klinik für Orthopädie und Unfallchirurgie Martin Luther Krankenhaus Berlin, Grunewald Akademisches Lehrkrankenhaus der Charité

2 Injury mechanism Petersen/Zantop: Anterior cruciate Ligament, DÄV

3 Subesequent injuries F F M T T T 42 yo wm 6 years post lateral meniskektomie

4 ACL rupture Subluxation, Giving way Meniscal injury Cartilage damage Arthritic changes (Daniel 1993) Dandy et al. 1994

5 Initial cartilage damage Kissing lesions

6 Initial cartilage damage 19 year old soccer player, ACL and cartilage damage M-ACI vs microfracture???

7 Knee Trauma Cascade Knee Trauma Meniscus Cartilage ACL ruptur Chronic instability Meniscus Cartilage Osteoarthritic changes Petersen and Zantop 2005

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10 Microfracture Female VB player, 23 yo ACL reconstruction 5 days prior

11 ACI versus Microfracture no significant difference Lysholm and VAS SF 36 sig better followingnach microfracture vs ACT Knutsen et al. 2004

12 Microfracture versus ACI? Not an equal battle Minimal invasive techniques

13 Porcine Femura: 25 (+/- 2) weeks 3d matrix: Bioseed C, Biotissue, Freiburg

14 Development of arthroscopic strategies Conventional suture technique 4 stitches PDS 6-0 USP (n=10)

15 Development of arthroscopic strategies Arthroscopisc technique transosseous Suture (2-0 suture) (n=10) Erggelet et al. 2003

16 Development of arthroscopic strategies Arthroscopic technique 2 biodegradable pins 16 mm SmartNail, Conmed, Linvatec (n=10) Petersen et al. 2007

17 Stiffness Sig differences conventional and transosseous suture vs. pin fixation

18 Maximal failure load Sig differences conventional and transosseous suture vs. pin fixation

19 Failure mode Conventional suture n=10 Transosseous Suture n=10 Pin fixation n=10

20 Pin insertion SAMIC Scaffold Augmented Microfracture Drilling the hole for the nail Perpendicular pin insertion

21 Pin Insertion Group A: intact knee Group B: cartilage defect Group C: Matrix fixed with suture Group D: Matrix fixed with pin perpendicular (90 ) Group E: Matrix fixed with pin perpendicular (60 )

22 Pressure distribution Intact defect matrix Pin 90 Pin 60

23 Pressure distribution Group D: Pin perpendicular Group E: Pin 60

24 Maximum load * A B C D E Intact cartilage Matrix Matrix Matrix Cartilage defect suture Pin in 90 Pin in 60 * p<0,05

25 Clinical impact

26 Clinical impact

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28 Prospective randomized clinical trial 3 centers T. Zantop Münster Germany R. Verdonk Gent Belgium C. Erggelet Zurich Switzerland 30 Patients Microfx 15 Patients AMIC (Chondrotissue) 15 Patients FU 12 weeks, 1 year, 2 years MRI, SF 36, VAS walking, VAS daily living activities, Tegner Score

29 Prospective randomized clinical trial male team handball player, * traumatic cartilage damage lateral FC Zantop and Petersen Arthroscopy in press

30 Follow up MRI 12 month postoperatively Zantop and Petersen Arthroscopy in press

31 Degenerative damage female, degenerative cartilage damage med FC Zantop and Petersen Arthroscopy in press

32 Follow up MRI 3 Tesla MR

33 Follow up MRI 3 Tesla MR Zantop and Petersen Arthroscopy in press

34 Conclusions Chondrotissue and BioSeed seem to have their place in threatment of cartilage defects Higher indication and success after SAMIC? Advantage of reduced arthroscopic morbidity Wait for multicenter results Get the patient well and back to sports

35 Thank you