Indications and Contraindications for Cartiform
|Isolated, full-thickness cartilage defect of the knee||Significant subchondral bone loss >5 mm|
|Defects size 1-2 cm2||Femoral defect with uncorrected malalignment, meniscal deficiency or ligament instability|
|Primary or revision cases||Patellar defect with uncorrected maltracking|
|Contained lesions||Uncontained lesions|
|Donor site preparation|
|- Ring curette|
|- PowerPick microdrilling system|
|- Cartiform viable osteochondral allograft implant|
|- 2.5-mm PushLock anchors (×3-4)|
|- 4-0 Monocryl suture (×3-4)|
|- 6-0 absorbable suture|
|- Fibrin glue|
Patient Positioning and Visualization
|Perform a diagnostic arthroscopy to ensure patient is a candidate prior to arthrotomy and opening of the implant||Performing an unnecessary arthrotomy to find a contraindication (e.g., subchondral defect)|
|Debride cartilage back to stable vertical borders and remove diseased surrounding cartilage||Failure to debride cartilage to create a contained lesion|
|Maintain 2-3 mm osseous bridges between drill holes||Creating a subchondral defect as a result of tunnel coalition between microfracture sites|
|Regularly assess the orientation of the allograft during preparation and implantation||Incongruent graft placement or loss of graft suitability as a result of error in orientation/preparation|
Arthrotomy and Visualization
Graft Site Preparation
- 0 to 6 weeks: Partial weight bearing in full extension while wearing a knee brace; immediate active and passive range of motion as tolerated.
- 6 weeks to 4 months: Gradual weight bearing as tolerated; the brace is discontinued; full knee range of motion; no knee loading beyond 90° of flexion.
- >4 months: Able to return to activity as tolerated.
|Single operation||Single implant limits to a 2-cm-diameter defect|
|No donor site morbidity||Unable to fill/restore a large osseous defect|
|Allograft is flexible and can contour to match lesion size/shape.||Theoretical risks with allograft tissue of disease transmission|
|Off the shelf use with long shelf-life||Unknown if subchondral bone should be microfractured or not to optimize ingrowth conditions|
- ICMJE author disclosure forms
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The authors report the following potential conflicts of interest or sources of funding: M.J.S. is a board member of the American Journal of Sports Medicine (money paid to institution); consultant for Arthrex (money paid to institution); and receives grants from Stryker (money paid to institution). D.B.F.S. is an editorial or governing board member of Cartilage (money paid to institution); is a paid consultant for Cartiheal, Smith & Nephew, and Vericel; and receives research support from Arthrex, Ivy Sports, and Smith & Nephew (money paid to institution). A.J.K. is a consultant for Arthrex (money paid to institution); grants from Arthritis Foundation, Ceterix, and Histogenics (money paid to institution); and payment for lectures including service on speakers bureaus, from Arthrex (money paid to institution). Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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