Damage to the articular cartilage surfaces in the knee causes pain and disability. Thinning and roughening of the articular cartilage can progress to severe wear and eventually patches of bare bone rubbing on bare bone in the knee (severe arthritis).
Articular cartilage has got no blood supply and therefore doesn’t heal up on its own or repair itself. There are a number of surgical techniques available for cartilage repair/replacement, and each has its own specific indications.
Microfracture is an ideal technique for treating small patches (ideally ~1cm2 defects). It can be performed easily via keyhole (arthroscopic) surgery, does not require complicated equipment and is cheap. It can give 80% success rates at 5-years follow-up. However, the bigger the area of cartilage damage, the worse the results tend to be, and microfracture does not tend to work well with areas of damage much greater than about 2cm2 .
For bigger cartilage defects, the best options currently available are either MACI (Matrix-induced Articular Cartilage Implantation /transplantation) or the use of a Chondrotissue Graft.
The Chondrotissue Graft is a high-tech scaffold that is a sterile absorbable matrix sponge-like textile made of non-woven polyglycolic acid treated with hyaluronic acid. It has been shown to induce mesenchymal progenitor cells (stem cells) to differentiate into cartilage cells. The larger patch of cartilage damage is treated by microfracture, but the Chondrotissue Graft is then fixed over the defect (using absorbable tacks and/or absorbable fibrin glue). The graft then ‘captures’ the blood, bone marrow cells and stem cells released by the microfracture, giving them a scaffold in which to grown and mature into new cartilage tissue.
Animal studies have shown that the new cartilage produced with Chondrotissue Grafts is superior in quality to that produced by microfracture alone, and highly encouraging clinical results are beginning to be reported in the scientific literature. It is, however, only with further time that we will have results to show us what the long term outcomes are comparing the Chondrotissue Graft to other techniques such as MACI. However, one of the main attractions of the Chondrotissue graft is that more invasive procedures such as MACI require 2 separate operations – #1 to harvest cartilage cells for culture, and #2 to implant the cultured cells – whereas Chondrotissue can be implanted by a single-stage operation and it is also considerably cheaper to use.
CLICK HERE to download a PDF copy of the abstracts booklet from The Chondrotissue Lead Users’ Update Meeting,Berlin, December 2011
CLICK HERE to read a case report of Chondrotissue grafting to the patella in a complex revision case by Mr Ian McDermott
The latest advance that we are now using in articular cartilage replacement surgery, in conjunction with Chondrotissue, is a biological glue called Vivostat Platelet Rich Fibrin (PRF).
Vivostat PRF has been used extensively for years in cardiac surgery, vascular surgery and plastic surgery. It involves taking a blood sample from the patient, spinning the blood down and extracting the fibrin (part of what forms a natural blood clot), combined with a high concentration of platelets (which also contact growth factors). This forms a biological glue that can be sprayed around the edges and over the top of the Chondrotissue graft, to help fix it firmly in place in the knee.
In the past we used to use Tisseel glue to secure grafts in place. However, Tisseel is a fibrin glue that’s manufactured from pooled blood donations (i.e. from multiple donors, all mixed in together), and it doesn’t contain platelets. Vivostat, on the other hand, comes from the patient’s own blood (autologous), so there are less concerns about potential disease transmission / infection. Also, Tisseel doesn’t contain platelets, whereas Vivostat PRF does. Therefore, Vivostat PRF is not just a biological bioabsorbable glue, but it is also autologous and ‘bioactive’ – to help try and promote healing of the tissue and in-growth of new cartilage.
For further information about Vivostat PRF please CLICK HERE
For further information, click here: http://kneereplacements.co.uk/articular-cartilage-grafting/
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