By Tom Minas MD MS

A Primer in Cartilage fix and Joint upkeep of the Knee offers the total diversity of treatments for a altering, more and more more youthful sufferer inhabitants. Dr. Thomas Minas demonstrates every one technique-from non-surgical to mini-incision overall knee arthroplasty to the new advancements in tissue biologics-through a step by step technique. This hugely visible, multimedia reference courses you in settling on the Read more...

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One player developed extensive continued delamination. Follow-up was short (1 year). The natural history of an untreated chondral injury is not yet known, although most agree that even small lesions (<1 cm2) likely will progress very slowly,19 with greater than 50% developing osteoarthritis over a 14-year follow-up. Marrow stimulation techniques, such as drilling, abrasion arthroplasty, and microfracture, attempt to induce a reparative response by perforating the subchondral bone after radical debridement of damaged cartilage and removing the tidemark “calcified” zone to enhance integration of repair tissue.

Several authors have conducted studies comparing different repair techniques, such as microfracture, mosaicplasty, and ACI, with conflicting results. These studies 42 PART 1 DECISION MAKING are often compromised by the nature of the procedures they were designed to investigate; for example, ACI as a cell-based therapy is dependent on a sophisticated cell culturing process. The cell culturing process requires phenotypic validation, cell viability assessment, and sterility process validation according to the FDA, GLP (Good Laboratory Practices), and GMP (Good Manufacturing Practices) to ensure sterile, safe, phenotypically stable cell implantation; however, not all authors use standardized and approved laboratory facilities.

The next-generation technique, ACI-C (collagen-covered), was developed to reduce the reoperation rate due to hypertrophy of the periosteal patch used to cover the defect. This was achieved by substituting periosteum with a collagen membrane that frequently consists of a porcine type I/III collagen bilayer membrane. The latest generation of ACI, MACI (membrane-associated), cultures the chondrocytes directly on the bilayer collagen membrane, which is then implanted arthroscopically or through a mini-open approach with fibrin glue or limited suturing.

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