![]() To better understand this process and identify risk factors and design interventions that could prevent or correct it, Mayo Clinic orthopedic specialists are developing a multicenter prospective study. Multicenter study of cartilage repair and osteoarthritisĮvidence links repair of anterior cruciate ligament (ACL) injury with the subsequent development of osteoarthritis in the knee. This environment ensures that the chondrocyte is maintained and stimulates the cells to produce the proteins that are crucial to the biomechanical function of cartilage. These cells are then embedded into a type 1 collagen matrix and incubated in a unique tissue processor that simulates the variation in pressure and low oxygen level of the knee joint. Similar to ACI, NeoCart is derived from the patient's own cartilage cells that are harvested arthroscopically. NeoCart represents a novel approach to the treatment of cartilage defects, and Mayo Clinic has been chosen as a test center for the phase III Food and Drug Administration trial, randomizing patients to microfracture versus NeoCart. Current drawbacks to this procedure are hypertrophy of the patch that can lead to further surgery and unreliable biological potential of the reimplanted cartilage cells. In ACI, healthy cartilage cells are harvested, cultured and then reimplanted into the defect under a patch at a second-stage surgery. Autologous chondrocyte implantation (ACI) can result in more hyaline-like cartilage within the treated defect. While this can have good results in smaller lesions, clinical studies reflect this lack of durability over a long-term follow-up. ![]() This type of cartilage is less durable, less resilient and less able to withstand shearing forces than is native articular cartilage. Microfracture is a marrow-stimulation technique that creates fibrocartilage at the site of the procedure. Right, juvenile particulated chondral allograft transplant. Left, cartilage defect after failed microfracture in the patella. Special attention needs to be directed to surgical indications, available techniques, clinical outcome data and quality of postoperative care." Randomized trial comparing NeoCart with microfracture Stuart: "We created the new surgical technique treatment algorithm because our practice includes a high volume of young athletes and active people with articular cartilage problems. Concomitant factors: Limb malalignment, ligament deficiency and meniscus insufficiency must be diagnosed and treated as necessary.Įxplains Dr.Lesion depth also is an important consideration to determine involvement of cartilage alone, or bone and cartilage (osteochondral defect). Lesion location is another relevant variable: femoral, tibial or patellar. The size and geometry of the defect can be quantified by MRI rendering of the largest diameter in two orthogonal planes to estimate the square area. Age, activity level, goals, expectations and demands of the individual influence the choice of treatment. Based on clinical experience and current scientific evidence, the algorithm prioritizes the following factors in treatment decisions: To help clarify clinical decision-making in this context of rapid change, the Mayo orthopedic team has created a surgical technique treatment algorithm. Three Mayo Clinic orthopedic innovations in cartilage-defect management are described below. While long-term research goals focus on harnessing stem cell therapies for renewal, in the near term, Mayo Clinic orthopedists choose from multiple treatment strategies to manage cartilage injuries. ![]() Untreated, these lesions can progress to more-serious degenerative joint conditions."Īrticular cartilage has only a single type of cell for renewal - the chondrocyte - which becomes less active with age and injury. Krych, M.D., "Full-thickness defects do not heal spontaneously and have limited ability to heal due to declining function of chondrocytes and the avascular nature of cartilage. "Joint surface defects are ubiquitous, with numerous studies reporting a 60 percent prevalence in knees undergoing arthroscopy for pain."Īdds his colleague, orthopedic surgeon Aaron J. Stuart, M.D., orthopedic surgeon at Mayo Clinic in Rochester, Minn. "Articular cartilage damage is caused by both acute and repetitive trauma resulting in knee pain, effusion or mechanical symptoms," explains Michael J. Right, intraoperative image shows osteochondral autograft mosaicplasty with two plugs. Left, image shows full-thickness chondral defect of the medial femoral condyle. ![]()
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