Particulated Juvenile Cartilage Allograft Research Articles

Treatment of osteochondral lesions in the ankle with a particulated juvenile cartilage allograft

Category: Ankle Introduction/Purpose: Numerous treatment modalities are in use today to treat symptomatic osteochondral lesions in the ankle; however, there are ongoing challenges with the treatment of certain types of lesions and concern regarding the long-term effectiveness of current common techniques. Methods: The purpose of this study was to collect mid and long-term clinical outcomes of pain, function, and activity level (VAS, SF-12, FAAM ADL, FAAM sports) Single-arm, multi-center study collected outcomes prospectively in standard clinic patients who would be undergoing or who had previously undergone treatment with DeNovo NT. The main exclusion criteria were high surgical risk, clinically diagnosed autoimmune diseases, or an active joint infection; all other patients receiving DeNovo NT could be approached for the study. The outcome analysis for this abstract focused on enrolled subjects’ final follow-up to date. Results: Clinical outcomes have been prospectively collected for 24 subjects with a total of 48 months follow-up. Twenty four of the treated lesions were located on the talus, none on the tibia. Out of the 24 patients, 23 had a single lesion and 1 had more than one. The average lesion size was 108.1 mm +/- 60.0 [23]. The Hepple classification was used to categorize each lesion. Interestingly, 19/24 were classified as 3 or higher. Cartilage ICRS was also used for classification. Out of the subjects, 23/24 were ICRS grade 3 or 4. There was also a concomitant procedure for 22/24 patients. Pre and post op VAS scores of 47.5 (+/- 23.1) and 12.2 +/- 17.8. SF-12 scores pre and post of 38.0 +/- 8.5 and 50.1 +/- 8.2. FAAM ADL’s pre and post 60.4 +/- 16.3 and 90.4 +/-11.8. FAAM sport scale scores pre and post 28.8 +/- 16.7 and 74.5 +/- 22.4. all outcome measures were statistically significant. Conclusion: Four year complete data is a challenge in this particular clinical population. This data set encompasses symptomatic osteochondral lesions of the talus treated with particulated juvenile cartilage allograft. The outcomes reflect an improvement in symptoms and patient satisfaction when treated with this technique. Based on these final outcome measures (V AS, SF-12, FAAM ADL’s, FAAM sport scale score) and satisfaction, it can be concluded that this is a viable option to get patients back to their pre-injury state.

First Metatarsal Head Osteochondral Defect Treatment With Particulated Juvenile Cartilage Allograft Transplantation: A Case Series.

Focal damage to articular cartilage, also called an osteochondral defect (OCD), can be a cause of pain and decreased range of motion. Recent advancements have led to transplantation techniques using particulated juvenile articular cartilage allograft. This technique has been applied to the first metatarsal head to a very limited degree, with no published results to our knowledge. The aim of this study was to review the clinical results of patients who underwent particulated juvenile cartilage allograft implantation for first metatarsal head OCDs. We performed a retrospective consecutive case series study. Nine patients, at an average age of 41 years, were treated for symptomatic focal osteochondral defects of the first metatarsal head with particulate cartilage grafting from 2010 to 2016. Patients were contacted by phone to assess interest in returning to the office for follow-up, where weightbearing radiographs of the foot were obtained and a foot examination was performed. At an average follow-up of 3.3 years, 7 of 9 patients reported no pain with recreational activities and no patient required further operations. This patient cohort was physically active, with 6 of 9 listing running as a regular activity. The average overall American Orthopaedic Foot & Ankle Society (AOFAS) Hallux Metatarsophalangeal-Interphalangeal Scale questionnaire score was 85 (maximum 100), AOFAS pain 35.6 (maximum 40), and AOFAS function 40.1 (maximum 45). Patient satisfaction surveys correlated with the AOFAS scores and revealed that 7 of 9 patients were very satisfied with their results, 1 was satisfied, and 1 patient was very dissatisfied. Particulated juvenile cartilage allograft transplantation is a promising treatment option for symptomatic first metatarsophalangeal focal articular cartilage lesions. Further study is needed to demonstrate which lesions respond better to this type of cartilage graft versus traditional marrow-stimulating procedures. Level IV, retrospective case series.

Comparative Outcomes for Treatment of Articular Cartilage Lesions in the Ankle with Particulated Juvenile Cartilage Allograft

Category: Ankle Introduction/Purpose: Treatment of osteochondral defects of the talus with particulated juvenile cartilage allograft is a relatively new procedure. Although other treatment options exist for large osteochondral defects of the talus, the potential advantage of particulated juvenile allograft is the ability to perform the procedure arthroscopically or through a minimal approach. No previous studies have looked at the results of an arthroscopic approach and no previous studies have compared an arthroscopic technique to an open approach. The purpose of this study was to compare the outcomes of an arthroscopic transfer technique to the previously published open technique. Methods: A total of 34 patients underwent treatment of talar cartilage lesions with juvenile particulated cartilage allograft. Twenty of these were done arthroscopically and 14 were done with an open arthrotomy. There was no statistically significant difference between the groups with respect to age, lesion width, lesion depth, lesion length, or operative time. Scores for 6 different validated outcome measures were recorded for patients in each group pre-operatively and subsequently at 6 months, 1 year, 18 months, and 2 years. Results: Comparing outcome measurements at each data point to baseline, there were no statistically significant post-operative differences found between open and arthroscopic approaches with regards to VAS Pain Scale, AOFAS Ankle-Hindfoot Scale, Foot and Ankle Ability Measure - Sport Scale, or SF12 Physical Health Scale. Conclusion: Treatment of talar articular cartilage lesions with particulated juvenile cartilage allograft is associated with improved outcomes at 2 years with regards to several validated outcome measures regardless of technique utilized. At 2 years follow up, there were no statistically significant differences in outcomes utilizing an arthroscopic technique versus open technique with the numbers given. This data supports the use of particulated juvenile cartilage allograft utilizing either arthroscopic or open techniques.

Joint Preservation of the 1st MTP

Category: Midfoot/Forefoot Introduction/Purpose: Focal damage to articular cartilage and the supporting subchondral plate, commonly referred to as an osteochondral defect (OCD), can be a cause of joint pain and subsequent decreased range of motion. There are few studies specifically describing these lesions in the first metatarsophalangeal (MTP) joint, where they are traditionally grouped into hallux rigidus. There exists an opportunity for early detection and intervention with the intent to prevent deterioration and improve patient outcomes. One contemporary treatment concept is to implant particulated juvenile cartilage allograft to restore articular cartilage. The aim of our study was to review the clinical results of patients that had undergone this procedure for first metatarsal head OCDs. Methods: After IRB approval, a retrospective review of a consecutive case series was studied utilizing the records of three foot and ankle surgeons. Inclusion criteria included all adult patients who were a minimum of one year post surgery and consented to participate. Patient demographics and preoperative visual analog scale (VAS) pain level were recorded from a standardized intake sheet. From the operative note, the OCD size and location was recorded, as well as any concomitant procedures. At a minimum follow up of one year, we obtained objective measurements of arthritis grade and subjective considerations of pain and function, including VAS pain level, Foot Function Index (FFI) questionnaire, the American Orthopaedic Foot and Ankle Society (AOFAS) Hallux Metatarsophalangeal-Interphalangeal scale, and an overall patient satisfaction score. Results: Nine patients met inclusion criteria, 4 males and 5 females. The average age was 41 years old (±11.77, range 21-65). The mean preoperative VAS pain score was 57.50 (±18.32, range 30-80). Four OCDs were located centrally on the first metatarsal head. The average OCD size intraoperatively was 30 mm2 (range 16-49). The average time since surgery was 3.26 years (±1.21, range 1.41-5.62). Average first MTP dorsiflexion was 41.78 degrees (±20.70, range 6-70). The average postoperative hallux rigidus classification was grade 2 (range 1-3). The mean VAS pain score improved to 5.22 (±8.44, range 0-20). The average AOFAS score was 88 (±15.91, range 52-100). The average FFI score was 8.04 (±12.60, range 0-30.6). All but one patient were satisfied or very satisfied with their results. Conclusion: At an average of 3.26 years postoperatively, patients had improved pain, did not show significant progression of their first MTP joint degeneration, and were satisfied with their results. Patients reported very little, if any, limitations in their activity level. We believe that articular damage of the first MTP should be viewed in the same way as OCD lesions in larger joints with emphasis on early detection and treatment to avoid the progression to arthritis. Particulated juvenile cartilage allograft is a valuable tool for surgeons to use in treating focal articular defects of the first metatarsal head.

Restoring Cartilage: The Holy Grail of Orthopaedics.

Theoretically, articular cartilage restoration should be a solvable biological/mechanical problem. But repairing, restoring, or replacing hyaline cartilage and the matrix that supports it presents formidable physiological and physical challenges. For decades, researchers have been investigating many different methods of cartilage repair, and no approach has yet risen to “gold standard” status. As the “Current Concepts Review” in the February 19, 2014, edition of JBJS points out, the main strategy for cartilage “self-repair” is bone marrow stimulation, primarily via microfracture. Restorative/replacement approaches focus on cartilaginous constructs composed of allogenic, autogenic, or tissue-engineered materials. This month’s “Case Connections” looks at four cases involving three different restorative/replacement approaches to cartilage defects. The variable outcomes emphasize the gaps between theoretical and clinical solutions to this common skeletal problem. In the June 24, 2015, edition of JBJS Case Connector, Ramirez et al. report on a high-school quarterback whose full-thickness glenoid osteochondral defect was filled arthroscopically with particulated juvenile cartilage allograft. The sixteen-year-old football player presented with a two-month history of right shoulder pain and a feeling of instability, precipitated by a tackle during a football game. Physical exam revealed forward shoulder elevation to 150° with moderate pain but no muscle atrophy. External rotation was 60°, and the shoulder rotated internally to the T7 vertebral level with pain and crepitus. Anterior apprehension, relocation, and load-shift tests were all positive. Radiographs showed a 2 × 2-cm lucency in the inferior-central region of the glenoid. MRI showed an anterior-inferior labral tear and an osteochondral glenoid defect that measured 1.7 × 2.5 cm. After a period of unsuccessful nonoperative management, diagnostic arthroscopy revealed a displaced anterior-inferior labrum and a full-thickness, 1.5 × 1.5-cm cartilage defect of the inferior-central region of the glenoid. Surgeons repaired the labrum arthroscopically and then dried the surface of the defect by …

Particulated Juvenile Cartilage Allograft Transplantation for the Treatment of Osteochondral Lesions of the Talus

Osteochondral lesions of the talus present a formidable treatment challenge to the orthopaedic surgeon. Although debridement with either microfracture, drilling, or curettage is often successful in relieving pain and growing fibrocartilage within a standard lesion, the option of implanting particulated juvenile cartilage allograft has become a promising treatment alternative for patients who have failed routine treatment or who have osteochondral lesions that are known to do poorly from the onset. Particulated juvenile cartilage allograft transplantation delivers 1 mm3 of fresh juvenile cartilage, which contain live cells in their native extracellular matrix, that are secured into the osteochondral defect with the use of a fibrin adhesive. The current evidence, indications, and surgical technique for the use of particulated juvenile cartilage allograft transplantation in the management of osteochondral lesions of the talus have been reviewed.

Particulated Juvenile Articular Cartilage Allograft Transplantation for Osteochondral Lesions of the Talus

Osteochondral lesions of the talus present a formidable treatment challenge to the orthopedic surgeon. This explains the multitude of treatment options described for this pathology. Currently, in the United States, surgical treatment options for symptomatic lesions are: debridement; marrow stimulation including drilling, microfracture, and abrasion arthroplasty; osteochondral autograft transfer; fresh osteochondral allograft transplantation; and the recently introduced technique of particulated juvenile cartilage allograft transplantation. The appropriate surgical therapy is based on patient and lesion-specific factors. This article will provide a brief review of these surgical therapies and the technique for particulated juvenile cartilage allograft transplantation.