Surgical Application, biomechanical and first clinical data of a matrix augmented microfracture procedure using chondrotissue

Transcription

1 Westfälische Wilhelms Universität Surgical Application, biomechanical and first clinical data of a matrix augmented microfracture procedure using chondrotissue Wolf Petersen Klinik für Unfall- Hand und Wiederherstellungschirurgie Westfälische Wilhelms Universität Münster

2 ACI versus Microfracture? No significant difference in Lysholm und VAS SF 36 significantly better after microfracture Knutsen et al. 2004

3 ACI versus Microfracture? Not an equal battle Minimal invasive techniques

4 Arthroscopic techniques Marcacci technique: Erggelet technique: Hyalograft Bioseed C - Easy to perform - Adhesion - Poor fixation strength (larger defects? No shoulder?) - Transfemoral suturing - Good fixation strength - Technically demanding

5 Surgical Application Smart nail, biodegradable pin (PLLA)

6 Surgical Application SAMIC Scaffold Augmented Microfracture Chondrotissue Smart nail, biodegradable pin (PLLA) PGA/Hyaluronean acid

7 SAMIC Microfx Scaffold Guided tissue regeneration Regenerate

8 Defect size SAMIC Scaffold Augmented Microfracture Specific needle (Karl Storz) Determination of the defect size: 20x10 mm

9 Scaffold preparation SAMIC Scaffold Augmented Microfracture Cutting of the scaffold Soak the implant in autologous human serum Chondrotissue

10 Arthroscopic Technique SAMIC Scaffold Augmented Microfracture Debridement Microfracture

11 Portals SAMIC Scaffold Augmented Microfracture 2. Medial: Matrix 1. Anterolateral: Visualiziation 3. Anteromedial: Pin insertion Three portals

12 Cannula SAMIC Scaffold Augmented Microfracture Cannula trough the medial portal

13 Matrix insertion SAMIC Scaffold Augmented Microfracture Chondrotissue

14 Arthroscopic Technique SAMIC Scaffold Augmented Microfracture Chondrotissue Matrix is held in place with the probe

15 Arthroscopic Technique SAMIC Scaffold Augmented Microfracture Smart nail 16 mm PLLA Resorbtion time 6-12 month Drilling the hole for the nail

16 Drilling SAMIC Scaffold Augmented Microfracture Drilling the hole for the nail

17 Pin insertion SAMIC Scaffold Augmented Microfracture Curl et al. Arthroscopy 1997 Application of the Smart nail

18 Result SAMIC Scaffold Augmented Microfracture

19 How many pins? SAMIC Scaffold Augmented Microfracture Two Smart nails 20 x 10 mm >20 mm

20 Biomechanical data

21 Biomechanical evaluation 3 dimensional matrix: Chondrotissue, Biotissue, Freiburg Porcine Femur: age 25 (+/- 2) weeks Zelle et al. Arthroscopy 10/2007

22 Material and Methods Conventional suture technique 4 sutures PDS 6-0 USP (n=10) Zelle et al. Arthroscopy 10/2007

23 Material and Methods Transosseous suture technique (2-0 Vicryl suture with 3 knots) (n=10) Zelle et al. Arthroscopy 10/2007

24 Material and Methods Arthroscopic technique with 2 biodegradable pins (16 mm SmartNail, Conmed, Linvatec) (n=10) Zelle et al. Arthroscopy 10/2007

25 Stiffness Steifigkeit N/mm Transosseous Transossäre Naht Konventionelle Pinfixation Conventional Pin Naht Sig difference conventional suture vs. transosseous suture and pin fixation

26 Yield load Versagenslast N Transossäre Naht Konventionelle Naht Pinfixation Transosseous Conventional Pin Sig difference conventional suture vs. transosseous suture and pin fixation

27 Max. load Maximale Versagenslast N Transosseous Transossäre Naht Konventionelle Conventional Pinfixation Pin Naht Sig difference conventional suture vs. transosseous suture and pin fixation

28 Failure mode Conventional suture n=10 Transosseous suture n=10 Pin fixation n=10

29 Conclusion Strctural properties of arthroscopic matrix fixation techniques are significantly better than the conventional suture technique

30 First clinical data 5 patients since March 2007 Age: years Defect size: cm² 4x medial femoral condyle 1x lateral femoral condyle Surgical time: mean 29 Minutes

31 First clinical data Rehab: - 6 weeks partial weight bearing No adverse effects: - no infection - no prolonged effusion - no allergicreaction

32 Prospective randomized clinical trial 5 centers W. Petersen Münster Germany D. Fritschy Géneve Switzerland R. Verdonk Gent Belgium C. Erggelet Zurich Switzerland Zorzi Verona Italy 30 Patients Microfx 15 Patients AMIC (Chondrotissue) 15 Patients FU 12 weeks, 1 year, 2 years MRI, SF 36, VAS walking, VAS daily living activities, Tegner Score

33 SAMIC Scaffold Augmented Microfracture Result presentation on ICRS 2009 in Miami?

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