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
- Cartilage injuries: A review of 31,516 knee arthroscopies.Arthroscopy. 1997; 13: 456-460
Krych AJ, Pareek A, King AH, Johnson NR, Stuart MJ, Williams RJ 3rd. Return to sport after the surgical management of articular cartilage lesions in the knee: A meta-analysis. Knee Surg Sports Traumatol Arthrosc August 18, 2016. [Epub ahead of print.]
- Management of articular cartilage defects of the knee.J Bone Joint Surg Am. 2010; 92: 994-1009
- Current concepts of articular cartilage restoration techniques in the knee.Sports Health. 2014; 6: 265-273
- Cost-effectiveness analysis of autologous chondrocyte implantation: A comparison of periosteal patch versus type I/III collagen membrane.Am J Sports Med. 2012; 40: 1252-1258
- Increased failure rate of autologous chondrocyte implantation after previous treatment with marrow stimulation techniques.Am J Sports Med. 2009; 37: 902-908
- Autologous chondrocyte implantation for focal chondral defects of the knee.Clin Orthop Relat Res. 2001; 391: S349-S361
- A randomized trial comparing autologous chondrocyte implantation with microfracture. Findings at five years.J Bone Joint Surg Am. 2007; 89: 2105-2112
- Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation.N Engl J Med. 1994; 331: 889-895
Osiris Therapeutics I. Characterization of Cartiform® viable osteochondral allograft. Cartiform White Paper 2015.
Osiris Therapeutics I. Cartiform® retains endogenous viable cells after two years storage at –80°C. Cartiform White Paper 2015.
Osiris Therapeutics I. Cartiform promotes mesenchymal stem cell migration and chondrogenesis. Cartiform White Paper 2015.
- Autologous osteochondral grafting in the knee: Indication, results, and reflections.Clin Orthop Relat Res. 2002; : 170-184
- Autologous cultured chondrocytes: Adverse events reported to the United States Food and Drug Administration.J Bone Joint Surg Am. 2006; 88: 503-507
- Articular cartilage repair using marrow stimulation augmented with a viable chondral allograft: 9-month postoperative histological evaluation.Case Rep Orthop. 2015; 2015: 617365
- A novel, cryopreserved, viable osteochondral allograft designed to augment marrow stimulation for articular cartilage repair.J Orthop Surg Res. 2015; 10: 66
- The use of osteochondral allografts in the management of cartilage defects.Curr Rev Musculoskelet Med. 2012; 5: 229-235
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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