LESS current treatment of cartilage defects
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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
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Agenda
Cartilage physiology
Cartilage defects
Epidemiology
Current Modalities of treatment
Future of cartilage injury treatment
1.
2.
5.
3.
4.
6. Summary and Questions
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Cartilage Physiology
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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
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Diagnosis
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Why treat?
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1. Conservative treatment
2. Micro-fracture
3. Autologous Chondrocyte Implantation
4. Biological Approach
5. Different Graft options
Summary of treatment options
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G. Bentley et al. / Injury, Int. J. Care Injured 44 (2013) S3–S10
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Conservative Management
NSAIDSPhysical therapyChondritin SulfateActivity Modification
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-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
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-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
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Autologous Chondrocyte Implantation ACI
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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
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Stem Cells
-New development-Research under way-Different types
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Combination therapy
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Questions, comments, concerns?www.frankmccormickmd.com
Online Appointments available at zocdoc.com