cartilage regeneration sarasota

Does it Work?-MFX/PRP

9 Months POST-OP

Medial Femoral Condyle Trochlea

Bennett Orthopedics and Sportsmedicine

copyright 2012

copyright 2012

OsteoChondral Autografting Strengths:

• May be performed arthroscopically

• Fills defect with native cartilage

Limitations:

• Limited to smaller defects

• Donor site morbidity

• No lateral integration

• Congruity of joint difficult to re-produce with multiple plugs

Courtesy of Brian Cole, MD Bennett Orthopedics and Sportsmedicine

Osteochondral Allografts

Strengths:

• Bone fixation

• Hyaline cartilage

Limitations:

• Limited supply

• Disease transmission

• Viability of chondrocytes

• Non-union


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copyright 2012


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

-Trend towards more normal appearing Cartilage with PRP -Trend towards better cartilage histology with PRP -Strong Type 2 collagen with PRP -less subchondarl bone cysts with plugs

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Pestka JM, MD, Gerrit Bode,1" MD; Gian Salzmann,1 MD,

Norbert P. Sudkamp,1" MD, PhD, Philipp Niemeyer. Clinical Outcome of Autologous Chondrocyte Implantation for Failed Microfracture Treatment of Full-Thickness Cartilage Defects of the Knee Joint. American Journal of Sports Medicine,

Vol. 40, 2012 Autologous chondrocyte implantation after failed microfracturing appears to be associated with a significantly higher failure rate and inferior clinical outcome when compared with ACI as a first-line treatment

So What is Left if These Techniques

Fail?


Autologous Chondrocyte

Implantation Strengths:

• Can produce hyaline-like cartilage in some patients

• Can fill defects regardless of size with functional repair tissue.

• Moderate to large defects that have failed previous intervention

Limitations: • More invasive

• Expense

• Longer recovery – return to sports


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Carticel Case-Steps


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Cartilage Cultures

Carticel- Genzyme

• Biopsy, 4-6 weeks later can replant with cultured cells, use periosteal patch, open surgery

• Next gen Carticel, MACI-matrix impregnated with cells, no periosteal patch


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How?

SCIENTISTS WIN NOBEL

PRIZE FOR STEM CELLS

Experiments by John B. Gurdon of the United Kingdom

and Shinya Yamanaka of Japan showed that mature cells taken from the body could be changed to an embryonic-like state in a laboratory dish, a head-spinning discovery that is the biological equivalent of turning back time

http://online.wsj.com/article/SB10000872396390444897304578043961363646792.html?mod=WSJ_hpp_LEFTTopStories

Wall Street Journal, October 08, 2012

Without this discovery, Carticel would not be possible

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Cartilage Cells


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Children First Macmull S,*1" MBBS, MRCS (Eng), Michael T. R.

Parratt,1 MBChB, MRCS (Ed), George Bentley,1 Dsc MB, ChM, FRCS, F Med Sci, John A. Skinner,f FRCS (Orth), Richard W. J. Carrington FRCS (Orth), Tim Morris. Autologous Chondrocyte Implantation in the Adolescent Knee. American Journal of Sports Medicine, Vol. 39, No. 8, 2011

Results show that, in this particular group who received ACI, patients experienced a reduction in pain and significant improvement in postoperative function after ACI or MACI. The authors believe that ACI is appropriate in the management of carefully selected adolescents with symptomatic chondral and osteochondral defects.

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Carticel Steps


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15 year old had absorbable pins for osteochondritis dissecans 2 years earlier in Port Charlotte, now with damage to cartilage

from pin

Preparation Drying

Carticel Steps Cont”d


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Carticel Steps Cont’d 2


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Carticel Steps cont’d 3


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Final Carticel Implant


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AMZ

Adult 49 y.o Female

Case with Patellar Malalignment


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Carticel Malalignment Case


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Juvenile Chondrocytes

Bennett Orthopedics and Sportsmedicine Regenerating the Youth in You!

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CaReS® - Collagen Matrix Seeded with Patient’s

own Chondrocytes

- Custom Fit by the Surgeon to the

Defect

- Physical Characteristics: Resilient,

Restores Biomechanical Properties

of Cartilage

- Launched in Germany, Austria,

Switzerland in 2003

- Strong International IP position

- Treated over 1100 Patients

-Excellent Safety Profile

-Muti-site Clincal Trials On-going

-Initial Clincal Results Presented at

EU Medical Conferences,

Publications Pending


copyright 2012

Competition:

-MACI, Genzyme/ Verigen: autologous cells are

seeded on one side of a collagen membrane,

fixation is done with Fibrin Glue

- Hylograft, Fidia: autologous cells are seeded in

hyaluronan membrane, fixation is done with

Fibrin Glue no known plans for US launch

- Bio Cart, Prochon: autologous cells are seeded

on a 3D fibrinogen membrane, fixation is done

with Fibrin Glue

- ChondroCelect, Tigenix is an improved

Carticel, claims to have developed biological

markers that select best chondrocytes for culture,

2 dimensional, requires sutured membrane


copyright 2012

Others Non US Approved as of

yet

Chondroselect

Tigenix

Hyalagraft

CaRes


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3.) Collagen Scaffold

Various Biologic scaffolds are used to replace injured tissue.

Collagen Meniscal Implant(Menaflex)

Graft Jacket_Rotator Cuff-human Epidermis

Allograpghs- bone grafts ligaments tendons


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Meniscal Scaffold

“Menaflex” Now there is a substance that can be put in when the

meniscus must be removed!

Bovine Collagen


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cartilage regeneration sarasota

Health & Medicine

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md bennett orthopedics

sports bennett orthopedics

plugs copyright

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thickness cartilage

native cartilage limitations

better cartilage histology