Name: Cartiform®: Cartilage Restoration Using a Novel Cryopreserved Viable Osteochondral Graft
Uploaded: 2015-02-17T00:00:00Z
Channel: Arthrex
Description: Jack Farr, MD, (Indianapolis, IN) provides a scientific and clinical discussion on Cartiform®, a viable osteochondral allograft that combines the safety and success of fresh osteochondral allografts with ease of use. Cartiform is available with a 2-year shelf life, stored at -80 degrees C.

<p>Jack Farr, MD, (Indianapolis, IN) provides a scientific and clinical discussion on Cartiform®, a viable osteochondral allograft that combines the safety and success of fresh osteochondral allografts with ease of use. Cartiform is available with a 2-year shelf life, stored at -80 degrees C.</p>

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VPT1-00408-EN | B | Cartiform®: Cartilage Restoration Using a Novel Cryopreserved Viable Osteochondral Graft

Jack Farr

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Cartiform®: Cartilage Restoration Using a Novel Cryopreserved Viable Osteochondral Graft

Hi, I'm doctor Jack Farr. I'm going to be discussing Cartiform. This is a new novel. Cryopreserve viable allograft. So when I was first presented with this, I thought back on what other experiences I had that I can relate to it. And I thought, how can I take my knowledge about particularly allograft juvenile cartilage? And you can see this is represented maybe as a donut holes. And these actually allow the cells to escape, migrate, multiply and form extracellular matrix. So Cartiform is sort of the opposite of that. In other words it is maybe the donut as particularly juvenile allograft is the donut hole. Cartiform is the donut. It still allows through these pores for cells to escape, migrate, multiply and potentially influence their environment. So what is Cartiform? It's cryopreserve viable allograft derived from human hyaline articular cartilage. It has many factors that can influence the local environment not only the cells, but also the extracellular matrix and chondrogenic proteins. The characteristics. It has a two year shelf life. Its a single step procedure. Potentially, it's easily cut and shaped and flexible so it can conform to the local topology. Especially important in the trochlea, it's fixed with fibrin glue, sutures or suture anchors, and it's available in 20 millimeter or 10 millimeter disks. As you can see, the native cartilage is preserved. You can see there's a superficial layer, a transitional layer, and a deep bony layer. You can see over time aggrecan is eluted. It's essential to have functioning chondrocytes, as we have known from frozen tissue in the past. Certainly it looks like cartilage for a while, and as the cells are not available to maintain the matrix, it gradually deteriorates. As you can see on the left, fresh, they're very they're very large population of viable chondrocytes. And then with direct freezing, very minimal chondrocytes survive, but with a controlled rate. Cryopreservation that's used for Cartiform you can see a much higher sustained viability. It's approximately 70% or greater. In addition to the chondrocytes. There are many growth factors that are available for facilitation of repair. So these can augment and influence mesenchymal stem cells that are locally available. These factors that we all know TGF beta BMP 247. And you can see the Cryopreserve has much higher contents of these, specifically TGF beta over time than the non cryopreserved or the dead cells. In addition, these proteins that are eluted actually influence mesenchymal cell migration. And you can see on the the right there is a bath. And this has Cartiform material in the the base. And then there are mesenchymal stem cells placed on this filter. And over time the mesenchymal stem cells migrate towards the proteins of the Cartiform. This is an example of its influence on mesenchymal stem cells. So mesenchyme stem cells in fibrin glue are spread in the pores and you can see on the left flash frozen. So flash frozen no real influence on the mesenchymal stem cells while on the cryopreserved they influence them and they become hyaline like cartilage. This is an in vivo goat study. It was comparing marrow stimulation to the Cartiform and marrow stimulation. And you can see on the left with Cartiform there is type two collagen, as you would expect with highland like cartilage. And on the right very minimal tissues available and certainly does not look like highland light cartilage. This is another series of slides, I think. To me, what's very important is looking at Basler integration. There's a lot of different types of cartilage restoration that we have available. And this is sort of the the the last horizon or the last frontier in getting whatever we're putting in to actually integrate with the the bone below. And you can see there's excellent Basler integration. And in addition there is marginal integration. And if you look at the type one, very minimal type one, type two, it's quite robust, very similar to the surrounding cells. So it does satisfy the criteria for highland like cartilage. If you compare it to other types of cartilage repair products, it has many advantages over any specific form. You can look at the viable sites. I think that's key for all types of cartilage products. It has genetic growth factors, maintenance of 3D architecture, and it's available on demand. This can be kept in a 80 -80 degree freezer on site has a long shelf life. It can be a single step procedure and there's no door morbidity obviously. So if you look at where this fits into the available cartilage restoration options, you can see on the left BioCartilage. These are for smaller, well contained lesions. And on the right fresh allograft. These are for very large lesions. Many times uncontained has bony involvement. And so in between these moderate sized lesions with good available bone would be where Cartiform would fit in to my type of use. These are some examples. These are clinical examples. So this is a trochlea repaired at nine months. This is courtesy of Jim Hoffman. And you can see it certainly looks Highland like very little type one collagen robust type two collagen. And the h.a and saffron. Oh both look like hyaline like cartilage. And if you look at the cell structure and you grade this. This is by independent pathologist. Using Ike's two parameters, you can see that Cartiform has excellent tissue morphology, matrix staining, cell morphology, and surface architecture. When compared to microfracture and the study that Brian Cole and I published on de Novo NDT, it's used predominantly so far in the knee with 74%. It's also been used in the foot shoulder lesion. Sizes are in the moderate size range, 2.4cm being the mean patients are mean age 35. This would be typical for all types of cartilage restoration procedures. And interestingly, 65% have been used with and 35% without marrow stimulation. And ongoing studies will tell us maybe which patients will benefit from additional marrow stimulation versus not using marrow stimulation. It's been used both in primary and revision types of procedures. And fixation is usually either with sutures and fiber and glue or suture anchors and fiber and glue. This is a patient of mine. This is a six month follow up. The patient had had several years of patellofemoral pain, had not responded to a prior debridement and subchondral plasty, and six months after his Cartiform his pain is resolved and he's returned to function. You can see on these T2 fat suppressed there is basilar integration. The Cartiform is approximately 1.5mm in thickness, and the surrounding cartilage on the patella was approximately 4 to 5mm. So you can see in addition to basilar integration, there's also been increase in the thickness of the Cartiform. And there's some early marginal integration. As you can see on the slides to the right. This is courtesy of Doctor Vangsness. And this is a patellar lesion. You can see nine months post op the bone marrow changes that were evident pre-op have now resolved. And there has been fill of the defect. And next is a clinical case of a femoral condyle. You can see this delamination pre-op post-op six months there's been good fill. And the 12 months. Not only is there good marginal integration basilar integration, but also I think very importantly we see that the bone marrow lesion has now subsided. For rehabilitation. I use typically the guidelines for cell therapy. These are well established and we've been using these for over 15 years with the one difference I don't want to have micro-motion at the base. So for the first 7 to 10 days I will allow these people have limited motion. And then after that their motion and weight bearing characteristics are very similar to cell therapy. This would be obviously a different protocol for patellofemoral versus tibial femoral. Thank you very much.

Cartiform®: Cartilage Restoration Using a Novel Cryopreserved Viable Osteochondral Graft

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