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SYMPTOMATIC cm FULL THICKNESS ARTICULAR CARTILAGE LESION IN

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SYMPTOMATIC cm FULL THICKNESS ARTICULAR CARTILAGE LESION IN Powered By Docstoc
					    HOW TO HANDLE A
   SYMPTOMATIC 2cm2
FULL THICKNESS ARTICULAR
   CARTILAGE LESION
   IN A YOUNG ATHLETE
       THAT HAS
 FAILED PREVIOUS REPAIR
            NICHOLAS SGAGLIONE , M.D.
             ASSOCIATE CHAIRMAN and PROGRAM DIRECTOR
                  DEPARTMENT OF ORTHOPAEDICS
NORTH SHORE UNIVERSITY HOSPITAL – LONG ISLAND JEWISH MEDICAL CENTER
              ASSOCIATE PROFESSOR OF ORTHOPAEDICS
               ALBERT EINSTEIN COLLEGE OF MEDICINE
DISCLOSURE
 Arthrocare, Biomet,
   ConMed, S & N
WHAT NOW?


    FAILED
   PRIMARY Rx
          GOALS
• ZONED HYALINE CARTILAGE

• PRACTICAL / ARTHROSCOPIC

• MINIMAL MORBIDITY

• COST EFFECTIVE

• SUCCESS – SHORT VS. LONG TERM

• OUTCOME          ARTHRITIS
          GOALS
• ZONED HYALINE CARTILAGE

• PRACTICAL / ARTHROSCOPIC

• MINIMAL MORBIDITY

• COST EFFECTIVE

• SUCCESS – SHORT VS. LONG TERM

• OUTCOME          ARTHRITIS
CHALLENGES
        TISSUE PROFILE
• HYALINE TISSUE DURABILITY
• 55 HISTO EVALS / ICRS Score / STIFFNESS
• SECOND LOOKS for OTHER PATH
      65% had Hyaline – like Tissue
• 2ND LOOKS for AC Lesion Site Failure
    Failures: 28% Hyaline – like Tissue
• CONCLUSION: HISTOLOGIC Correlation
                                HENDERSON, CORR, 2006
          GOALS
• ZONED HYALINE CARTILAGE

• PRACTICAL / ARTHROSCOPIC

• MINIMAL MORBIDITY

• COST EFFECTIVE

• SUCCESS – SHORT VS. LONG TERM

• OUTCOME          ARTHRITIS
PRACTICAL TECHNIQUE
  POSTOP
  REGIMEN

• POSTOP CPM / 0 – 900 ROM / Increase as tol.
• NWB x 3 WEEKS / CYCLING 2 - 3 WEEKS
• PWB x 3 WEEKS / WBAT at 6 WEEKS
• RETURN to SPORTS 4 – 6 MOS
          GOALS
• ZONED HYALINE CARTILAGE

• PRACTICAL / ARTHROSCOPIC

• MINIMAL MORBIDITY

• COST EFFECTIVE

• SUCCESS – SHORT VS. LONG TERM

• OUTCOME          ARTHRITIS
HARVEST SITE MORBIDITY
• 112 Pts w ASx Knee OC Harvest
• Ankle OCL Talus Cases
• Mean F/U 55 mos (25 – 124)
• WOMAC / LYSHOLM SCORES
• FUNCTIONAL OUTCOME OF KNEE
    WAS NOT AFFECTED
                               PAUL, JBJS, 2009
                                LEVEL IV STUDY
          GOALS
• ZONED HYALINE CARTILAGE

• PRACTICAL / ARTHROSCOPIC

• MINIMAL MORBIDITY

• COST EFFECTIVE

• SUCCESS – SHORT VS. LONG TERM

• OUTCOME          ARTHRITIS
        COST EFFECTIVE
• INDEX INTERVENTION

• POS

• SINGLE STAGE
                       OATs
• REIMBURSABLE 1/05

• 29866 / 13.88 RVUs

• HEALS BONE–BONE
          GOALS
• ZONED HYALINE CARTILAGE

• PRACTICAL / ARTHROSCOPIC

• MINIMAL MORBIDITY

• COST EFFECTIVE

• SUCCESS – SHORT VS. LONG TERM

• OUTCOME          ARTHRITIS
        CLINICAL OUTCOME

• 597 Condylar / 118 Patellofemoral Cases
• Avg age 27 (16 – 47) / 24 - 48 mon F/U
• 1 – 4 cm2 lesions (Avg = 1cm2)

• 85% Underwent Concomitant Surgeries
• HSS / LYS / ICRS / Mod Cincin / Bandi Scores
• 92 % G to E Success / 3 % Donor Site Morbid.
                                  Hangody, JBJS, 2003
                            LEVEL 4 RETRO. CASE SERIES
         CLINICAL OUTCOME

• 36 Condyle pts Rx'd with 6 mm Mitek COR
• Avg age 43 (19 – 66) / 48 mon F/U (24 – 89)
• No associated ACL surgery
• 1 – 2.5 cm lesions /avg. 2.2 grafts/case(1- 4)
• Lysholm: preop 44 to 84 / 67% G to E
• 14 2nd looks at up to 87 mos: all incorporated

                          Barber & Chow, Arthroscopy, 2006
                           LEVEL 4 RETRO. CASE SERIES
         CLINICAL OUTCOME

• Prospective Case Series: 37 Active pts.
• Avg age 29 (17 – 46) / 7 year F/U
• 11 OATs / 6 ACLR / 10 pm / 1 ACLR + pm
• 1.0 – 2.5 cm (1.9cm2) / No Axial Malalignment
• 77% G to E on ICRS / LFC (100%) > MFC (65)
• MRI in 24 / 27 : 60% Optimal Fill & Integration

                              Marcacci, Arthroscopy, 2007
                             LEVEL 4 PROSP. CASE SERIES
    ANY
COMPARISON
DATA?........
   OATs vs. MICROFRACTURE
                               LEVEL 1 PRCT / 2.8 cm2

• 28 OATs vs. 29 MFx / All Comp. Athletes
• Avg Age 24 yrs (15 – 40) / Mean F/U 37m
• Overall Success: HSS / ICRS / Xray
     OATs G to E: 96% vs. 52% for MFx
• Functional RTS: OATS 93% vs. 52% MFx
• MRI Tissue Fill: OATs 84% vs. 49% for MFx
• 58% Biopsied at 1 yr / ICRS Tissue Asses.
     OATs G to E: 84% vs. 57% for MFx
                         GUDAS, Arthroscopy, 2005
         GOALS
 ZONED HYALINE CARTILAGE

 PRACTICAL / ARTHROSCOPIC

 MINIMAL MORBIDITY

 COST EFFECTIVE / REIMBURSABLE

 SUCCESS – SHORT VS. LONG TERM

? TEMP. OUTCOME       ARTHRITIS
THANK YOU
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