Abstract
Surgical Technique
Indications and Contraindications for Cartiform
Indications | Contraindications |
---|---|
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 |
Special Equipment/Instrumentation |
---|
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 |
Graft Preparation

Patient Positioning and Visualization
Pearls | Pitfalls |
---|---|
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

Graft Implantation


Closure
Rehabilitation
- 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.
Discussion
Advantages | Disadvantages |
---|---|
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 |
Supplementary Data
- Video 1
This video shows Cartiform implantation for treatment of a full-thickness cartilage defect on the undersurface of the patella. The patient is positioned supine and a lateral parapatellar approach is performed on the left knee. The patella is everted to expose a 2 × 2-cm cartilage defect on its undersurface. The cartilage defect is debrided back to a stable border and the calcified cartilage layer is removed. The bone bed is biologically prepared by drilling at 3-mm increments to promote bleeding. The Cartiform implant is trimmed to match the defect before being secured in place with 3 PushLock anchors. The final construct is sealed with fibrin glue.
- ICMJE author disclosure forms
References
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Article info
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Footnotes
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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