less current treatment of cartilage defects

Current Concepts for Cartilage Defect

Treatment Options

Frank McCormick M.DSamuel Rosas MSIV

www.FrankMcCormickMD.comLESS Surgical Institute

Shoulder and Sports DivisionMiami/Fort Lauderdale/Boca Raton/West Palm Beach/ Orlando

Agenda

Cartilage physiology

Cartilage defects

Epidemiology

Current Modalities of treatment

Future of cartilage injury treatment

1.

2.

5.

3.

4.

6. Summary and Questions

Cartilage Physiology

Epidemiology

66% of patients had a cartilage defect N= 993

11% full thickness pathology

Athletic population:

N= 99336% full thickness lesion

2 Million Ankle sprains per yea. 50% likely result in a chondral defect

Diagnosis

Why treat?

1. Conservative treatment

2. Micro-fracture

3. Autologous Chondrocyte Implantation

4. Biological Approach

5. Different Graft options

Summary of treatment options

G. Bentley et al. / Injury, Int. J. Care Injured 44 (2013) S3–S10

Conservative Management

NSAIDSPhysical therapyChondritin SulfateActivity Modification

-Bone marrow stimulation technique

-Can be done arthroscopically

-No additional cost to the procedure

-No difference vs OAT vs chondroplasty in 32 patients at mean follow up period of 33 months.

-Best for small defects: less than 15mm

-Great option for competitive athlete who needs quick recovery

-Beyond 5 years, treatment failure may be expected

Microfracture

-Using a transplant from a fresh cadaver-Used for larger defects-Bacterial and PCR testing must be done first-transplant intact cartilage and bone-Only available in US

Osteochondral allograft transplantation

Autologous Chondrocyte Implantation ACI

Biological approachPlatelet rich plasma = PRP

-More than 800 proteins-More than 1.500 bioactive factors-Ex: Ca, IL, ADP, ATP, AA, Histamine, 5HT, Dopamine, IGF-1, TGF-B, HGH…

Adding PRP to MSC increased differentiation when in a chondrocyte medium

Stem Cells

-New development-Research under way-Different types

Combination therapy

Questions, comments, concerns?www.frankmccormickmd.com

drfrankmccormick@yahoo.com

Online Appointments available at zocdoc.com