28 28 yea ear o old Basketbal all Pl Player er w with 2c 2cm - - PowerPoint PPT Presentation

28 28 yea ear o

• ld Basketbal

all Pl Player er w with 2c 2cm MFC d C defec ect, st post Men eniscec ectom

• my 5

5 yea ears a ago:

• :

“MACI is the answer” in 7 minutes

Christian Lattermann, MD Professor Vice-Chair Clinical Research University of Kentucky

I do have financial disclosures to make

• Industry:
• Vericel: Consultant
• Cartiheal: Consultant
• Samumed: Consultant
• Novartis: Consultant
• Smith&Nephew : Institutional Support
• Current Grant Support:
• NIH-NIAMS: 1K23AR060275-01A1 (2012-2017)
• Editorial Board Memberships:
• Cartilage
• Journal of Sports Rehabilitation
• The Knee
• Orthopaedic Journal of Sports Medicine
• Reviewer for Journals:
• AJSM, CORR, JKS, O&C, Orthopaedics,
• Patents:
• 09/561,524 ;PCT/EP98/06849

This is Vegas and the gloves are off!

• this is a totally biased presentation
• I love Bill Bugbee and Kevin Bonner
• Bugbee is a nice guy, but helpless when

he does not have a bone plug

• Bonner is a saint, no matter how hard I

try, I cannot find anything on him

• Just assume that I am right, because this

is Plancher’s meeting and he said so!

Activity level:

High impact sports

Comorbidities:

meniscectomy 5 years ago => likely tolerated well

Alignment: neutral or valgus 2cm2 in large knee maybe a small defect

Bissel et al, BMJ 2008

• Ideal lesion characteristics: 2-10cm2
• Ideal age: 18-40
• Excellent track record in high level athletes

This is precisely what MACI is made for and I have 10 year data to prove it!

• Why would I want to violate the subchondral bone?
• Why would I use a product that has no track record?
• Why would I use a technique that has failed us

multiple times reliably in high level athletes?

• Why destroy subchondral bone if not necessary?
• Stick with the first line cellular technique that

has proven short and long term outcomes equal if not better than OCA

• I do not like to rely on magic and good will to

address a treatable problem such as this.

• Stick with what is tried and true, even if it may

look less flashy and easy

Be real! There is no Magic!

• Scope needed:
• No big deal, most chondral lesions require a previous scope

inspection

• Glued patch:
• Easy handling, no sutures any longer
• Small arthrotomy:
• Mini-arthrotomy, enlarged portal
• 30 minute surgery

Cell based:

• in this case indicated and first line

Allograft:

• is not a first line procedure unless subchondral bone is

involved

Autograft:

• not indicated for this size,
• Donor site morbidity

Marrow stimulation:

• History of early failure
• Microfx +: “Cartilage Voodoo”

• Manage Expectations
• Avoid linear thinking
• Be honest with your patient
• Do not succumb to “helperism”
• Be familiar with your techniques
• Look at data!