Chondral Injuries are one of the technically challenging cases for sports injury surgeons. There are various techniques described including lavage, abrasion chondroplasty, micro fracture, Mosaicplasty, ACI - various generations and newly developed Bioprinting
(Rocky) Jaipur Call Girl - 09521753030 Escorts Service 50% Off with Cash ON D...
Chondral Injuries - Current Concepts in Management & Cartilage Regeneration
1. 10/01/2015 IASM Mumbai
Current Management Strategy for
chondral injuries in athletes:
Square Pegs in Round Holes!
Dr Vaibhav Bagaria
MBBS MS Dip SICOT
CARE hospital & ORIGYN Clinic
Nagpur, India
drbagaria.com
2. Ideal Cartilage restoration
✤ “Chasing the Holy Grail”
✤ Can we recreate what God created?
✤ ‘Dil Mange more’
✤ Question: Are we trying square pegs in round holes?
drbagaria.com
13. Debridement & Lavage
✤ Chondral Lesions less than 2 Sq cm
✤ Remove Loose cartilage fragments & washout
✤ Good for low demand, older age pt who may not tolerate prolonged
immobility
✤ Considered palliative, yet quick recovery with QOL improvement
and fast mobility.
drbagaria.com
14. Microfractures
✤ Less than 2 - 3 sq cm lesions
✤ Reparative strategy
✤ Drilling holes 0.5 -1mm dia thro articular cartilage into bone marrow
cavity
✤ Allows access to bone marrow progenitor cells
✤ CPM with ltd activity required postop for healing
✤ Hyaline like cartilage that deteriorate over time.
drbagaria.com
17. Abrasion Chondroplasty
✤ Abrading subchondral bone superficially
✤ Intraosseous space opens up with vessels n mesenchyme
✤ Stimulates reparative process.
drbagaria.com
19. Osteochondral Transplantation
✤ Could be Allo or auto
✤ Commomest auto: Mosaicplaty ( S & N); OATS ( Arthrex)
✤ Good for Intermediate defects upto 5 sq cm
✤ Viability of harvested graft is the question
drbagaria.com
20. Technique
✤ Harvesting from NWB areas
✤ Cylindrical osteochondral grafts
✤ Transferred to WB area
✤ 2-5 sq cm
✤ Non degenerate knees only
drbagaria.com
23. Regeneration Strategy Triad
✤ Cells are required for de novo synthesis
✤ Scaffold provide the template to lay down the matrix
✤ Biological signalling molecule required to stimulate cell requirement,
migration, differentiation as well as synthesis
drbagaria.com
25. ACI - First Gen
✤ Cells isolated from NWB area
✤ Expanded in vito and transplanted to a defect
✤ Covered with periosteal flap
✤ Main drawback: two staged, time interval
drbagaria.com
27. ACI - Gen 2
✤ Drawback of Gen 1: graft delamination, ectopic calcification, graft
hypertrophy - mech symptoms “catching”
✤ 2nd gen - combines scaffold and cultured cells
✤ Scaffold provides structure for chondrocyte adhesion, expansion
while maintaining the chondrocyte phenotype.
✤ Can be used to treat relatively large chondral defecrs
drbagaria.com
28. ACI Gen 2
✤ MACI - Porcine collagen I/ III matrix
✤ Hyalograft C- Hyaluronic acid scaffold
✤ Bioseed C - Polyglactin/poly - p - dioxan
✤ CaRes - 3D type 1 Collage
✤ Cartipatch hydrogel composed of alginate and agarose (inserted in
mosaic fashion
✤ Novocart 3D – collagen-based biphasic scaffold (specific protective
layer, collagen sponge)
BioCart IIBioCart II – freeze-dried homologous human fibrinogen and recombinant hyaluran– freeze-dried homologous human fibrinogen and recombinant hyaluran
drbagaria.com
35. Bio Printing
✤ 3D Printing: Layered approach instead of suspension
✤ Create 3D multi-materials that mimic geometry of living tissue
✤ www.3dpost.in
drbagaria.com
36. Take home...
✤ Various strategies
✤ Numerous choices - superiority of one over another not established
✤ Customised Solution to your athletes
✤ Personal Choice: KISS: less than 2 sq cm: Micro fracture More than 2
sq cm: Offer 2nd gen ACI/ single stage BMAC repair
✤ Keep an eye for things on horizon
drbagaria.com
