Embed Size (px)
Citation preview
Section #2
Adult Chondrocyte Cells
Cartilage cells- Adult Mature Cells
• Biopsy taken with Arthroscopy
• Grown in a Lab-”Carticel”-Cambridge. Ma
• Open surgery-later
• More Later, but lets give you an overview of the general approach to the treatment of articular cartilage injuries. Bennett Orthopedics and Sportsmedicine
copyright 2012
Articular Cartilage Cells
Adult Cells- don’t replicate well
Have no blood supply
Have no nerve supply
Surrounded by extracellular matrix
When damaged-heal with fibrocartilage-which is inferior to hyaline cartilage (chondrocyte) –the normal type of cartilage found in our articulating joints
Meniscus-is fibrocartilage- cell is fibrochondrocyte
Bennett Orthopedics and Sportsmedicine copyright 2012
Cartilage
Meniscus- fibrocartilage-collagen type 1
Articular Cartilage-Hyaline cartilage-collagen type 2, although there are many others
Damaged Articular Cartilage- fibrocartilage-Collagen Type 1
Microfractured Cartilage-hyalinecartilage-Collagen Type 2
copyright 2012
Bennett Orthopedics and Sportsmedicine
Normal Articular Hyaline
Cartilage
copyright 2012
Bennett Orthopedics and Sportsmedicine
Acute Cartilage Damage
Precursor to Arthritis
Bennett Orthopedics and Sportsmedicine
copyright 2012
Chronic Hyaline Cartilage
Damage-Chondromalcia
Patella Trochlea
Bennett Orthopedics and Sportsmedicine
copyright 2012
Cartilage Treatment.
Lavage and debridement-no repair
Chondroplasty-no repair
Microfracture-heals with fibrocartilage
Oats-only small areas
Polymer bone plugs-not good
Osteochondral allografts-ok
Cartilage cultures- Genzyme only • Cambridge, Ma- near normal hyaline
cartilage
IVASIVENESS
C ARTILAGE
QUALITY
Bennett Orthopedics and Sportsmedicine copyright 2012
Debridement & Lavage
Strengths:
• Arthroscopic
• Does not violate sub-chondral bone
• Temporary pain relief
Limitations:
• Lack of tissue fill / restoration
• Low prospects for long
term result
Bennett Orthopedics and Sportsmedicine
copyright 2012
MicroFracture-Marrow
Stimulation Strengths:
• Arthroscopic
• Relatively simple procedure
Limitations:
• Creates fibro-cartilage / poor wear characteristics
• More effective on smaller defects
• 6-8 weeks non-weight-bearing and CPM required to optimize results
Bennett Orthopedics and Sportsmedicine
copyright 2012
Microfracture
Medial Femoral Condyle
Bennett Orthopedics and Sportsmedicine
copyright 2012
Microfracture Video
Medial Femoral Condyle
Bennett Orthopedics and Sportsmedicine
copyright 2012
Microfracture Trochlea
Bennett Orthopedics and Sportsmedicine
copyright 2012
Microfracture Video Trochlea
Bennett Orthopedics and Sportsmedicine
copyright 2012
copyright 2012
Chen,* PhD, Anik Chevrier,* PhD, Caroline D, Hoemann,*1" PhD, Jun Sun,* MD, Wei Ouyang,* PhD, and Michael D. Buschmann. Characterization of Subchondral Bone Repair for Marrow-Stimulated Chondral Defects and Its Relationship to Articular Cartilage Resurfacing. American Journal of Sports Medicine, Vol. 39, No. 8, 2011 1.) Fibocartilage 2.) Bone marrow stimulation does not reconstitute normal bone structure. Strategies that increase subchondral bone involvement in marrow stimulation could further benefit cartilage repair 3.) Lasts 3-4 years
Bone Marrow Stimulation-Microfracture
Bennett Orthopedics and Sportsmedicine
How Can I improve upon this with an Arthroscopic procedure?
PRP Stimulates Cartilage
International Cartilage Repair Society, 10th World Congress, Montreal 2012
copyright 2012
PRP and Cartilage
Bennett Orthopedics and Sportsmedicine Regenerating the Youth in You!
copyright 2012
Microfracture/PRP Application
OR View
Bennett Orthopedics and Sportsmedicine
copyright 2012
Insertion PRP/Knee
Bennett Orthopedics and Sportsmedicine
copyright 2012
Microfracture Knee
OR View
Bennett Orthopedics and Sportsmedicine copyright 2012
Microfracture/PRP
OR View
Bennett Orthopedics and Sportsmedicine
copyright 2012
Microfracture/PRP
Bennett Orthopedics and Sportsmedicine
copyright 2012
SemiAutologous Fibrin Glue
Bennett Orthopedics and Sportsmedicine
copyright 2012
Fibrin Glue Insertion Knee
Bennett Orthopedics and Sportsmedicine
copyright 2012
MicroFracture/Fibrin Glue
Monitor View
Bennett Orthopedics and Sportsmedicine
copyright 2012
Microfracture/PRP/FibrinGlue
Bennett Orthopedics and Sportsmedicine
copyright 2012
Microfracture Video
PRP/Fibrin Glue
Bennett Orthopedics and Sportsmedicine
copyright 2012
copyright 2012
Bennett Orthopedics and Sportsmedicine
The Augmentation of a Collagen/Glycosaminoglycan BiPhasic Osteochondral Scaffold with Platelet-Rich Plasma And Concentrated Bone Marrow Aspirate for Osteochondral
Defect Repair in Sheep Getgood A. et Al.
Cartilage October 3(4) 351-363, 2012
*Leukocyte Concentration did not negatively affect the positive affects of PRP when creating a more normal appearing cartilage, and creating closer hyaline cartilage as evidenced by increased collagen Type 2 with immunohistochemical analysis *Negative relationship between platelet concentrations above 1 million platelets/micro-liter • Addition of PRP created firmer cartilage • Addition of PRP less subchondral bone cysts
copyright 2012
Kisiday JD, C., Wayne Mcllwraith, William G.
Rodkey, David D. Frisbie, J.Richard
Steadman. Effects of Platelet-Rich Plasma
Composition on Anabolic and Catabolic
Activities in Equine Cartilage and Meniscal
Explants. Cartilage.3(3) 245-254
Suggests that Leukocytes may not be
good for joints- IL-1beta its effect? Not
solid study-in vitro(-/+) However,
cartilage looked and felt more normal
Bennett Orthopedics and Sportsmedicine
