Name: Cartiform® Viable Osteochondral Allograft: A Review of Outcomes in the Knee
Uploaded: 2018-09-27T00:00:00Z
Channel: Arthrex

R. Jay Bradley, MD, (New Bern, NC) presents early outcomes of Cartiform®* viable osteochondral allograft from his first 20-patient case series. Dr. Bradley has incorporated Cartiform viable osteochondral allograft into his surgical treatment algorithm due to the ease of use to implant, on-demand availability of the allograft, and good to excellent outcomes in his patients.
*Cartiform is a registered trademark of Osiris Therapeutics, Inc.

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VPT1-00922-EN | A | Cartiform® Viable Osteochondral Allograft: A Review of Outcomes in the Knee

R. Jay Bradley

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Cartiform® Viable Osteochondral Allograft: A Review of Outcomes in the Knee

Hi, my name is Jay Bradley. I'm with Carolina Orthopedics and Sports Medicine in New Bern, North Carolina. I'm going to talk today a little bit about Cartiform utilization and some technical pearls and early results. Looking at Cartiform, this is a relatively new viable osteochondral allograft. It's been a great asset to have available in the Or out of the freezer and able to be thawed and used at a moment's notice. It really is state of the art in having viable chondrocytes, a stable extracellular matrix that has chondrogenic growth factors, and mesenchymal stem cell chemotactic factors. This recruits these cells to the graft sites, and it provides stable fixation, really at a procedure that can be done on site at one time and end up with a result with type two collagen in your in your defect y Cartiform. Very important with the growth and Growth and chemotactic factors. These chondrocytes that are present in the graft really help guide the stem cells for the type two collagen. It's a structural graft. It's fairly easy to gain solid fixation that you can be comfortable with leaving the operating room. I think it's very important you're able to trim the graft, as opposed to some older techniques or even the larger bulk allografts, which are still very important in some situations. This allows the surgeon the opportunity not to have to really destroy or remove intact cartilage, just to create a circle or an oval, that you can actually trim the graft to preserve the native viable cartilage. It is flexible to allow for your radius of curvature or trochlear or patellar applications. And again, it's readily available. And for my indications these are for grade four chondral lesions or grade three chondral lesions with subchondral edema by MRI and most OCD lesions those at Those, at least, that are amenable to the osteochondral allograft and may even require some bone graft. So looking at this, we're just going to go over some of my patients. These are my first 20 Osteochondral allografts. And of these first 20, there were an even distribution of ten males and ten females. Three of these patients were hybrid grafts. I used Cartiform and an OATS procedure. And that's osteochondral autograft with that. So for the rehab, these are two summary pages from a rehab packet that I give to the patient. You can look at these options basically much earlier. Weight bearing with the patella and trochlear grafts protect the weight bearing a little longer for sure with the femoral condyle grafts. And you can see some of the specifics in this. I will say I think it's been very important whether just a simple summary slide or even a more involved packet. I give this to the patients and also provide this for the patients to take to their physical therapy. Is not all of the rehab centers in in your area may be comfortable with this, especially if it's new? I found this helpful early on to not have to explain this every time to the different rehab centers that people end up going to. So in summary, my early results, the first 20 Cartiform I had the average age of the patient was 43.8 years. The range was 16 to 58. Really leaned much more. Interestingly enough, in my practice to an older population in this range with with a couple of the really young patients there, but mostly 30 and 40, there were three complications. One patient had a DVT which resolved in three months with Xarelto. I put all of these patients on a full strength aspirin twice a day, and for the most part, they've done very well. I've had two patients with stiffness requiring manipulation under anesthesia. At least one of those has been done. One is scheduled on average, the patients that work or are planning to go back to work. The average has been a three month full return to work with no restrictions. And then looking at the patients with at least six months of follow up, that was ten of these patients. There's been 80% good to excellent results. One patient with fair results. This patient is the one still planning a manipulation and one patient with a poor result. They have ongoing pain. It's really a workers compensation dilemma. And in this patient, arthroplasty may be an outcome. Generally speaking, I've found that isolated lesions fare better than multiple lesions or kissing lesions. Not surprisingly, the younger patients more consistently are completely better. But still, there is significant improvement to be had in all the ages included. And certainly the shoulder and tibia cases were very challenging with their access.

Cartiform® Viable Osteochondral Allograft: A Review of Outcomes in the Knee

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