How do I approach t the e 37 37 y yea ear old r runner er wi - - PowerPoint PPT Presentation

How do I approach t the “ e “37 37 y yea ear

• ld r

runner er wi with OC OC defec ect”: ”:?

Christian Lattermann, MD Professor Vice-Chair Clinical Research

• Dept. Orthopaedic Surgery and Sports Medicine

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

Activity level:

Long distance runner Recreational runner Gait / form Recent changes to his technique

Pain characteristics:

Only with running activity or with any

activity

Sharp and specific or dull and achy Accompanied with effusion or not Mechanical Location

• Long leg alignment films are mandatory if you

evaluate for chondral defects

• Correct if more than 3-5 degrees varus or valgus
• Does location of lesion correspond with

malalignment?

• What effect does unloading have?
• If PF joint: assess instability/ PF overload

Location:

• Condyle:
• midcenter MFC or LFC, small lesion (2cm2): autologous cell therapy or OCA
• periphery, uncontained lesion: autologous cell therapy
• PF joint:
• first line autologous cell therapy or allogeneic cell therapy
• OCA and autograft plugs only in revision situations

Size:

• Fixable: repair
• salvage (larger than 6cm2): salvage

Depth:

• chondral: autologous cell based > OCA
• Subchondral: OCA > cell based

OA:

• Scope appearance
• Synovitis
• Other compartments?
• => any cell or chondral plug technique will have reduced outcomes

expectations and an increase in failure rate

• Patient expectations:
• Return to previous level or not?
• A conditioned runner who developed the lesion during his normal routine
• Return to higher level?
• The 39 year old weekend warrior who decided that a marathon or 10 have to be completed before

the end of year (the cross-fit phenomenon)

• Timelines for recovery:
• Realistic time frame for cartilage surgery recovery:
• i.e. crutches, PT, car driving
• Realistic time frame for return to running:
• i.e. 6-9 months or more, reduction in frequency and intensity likely
• Endgame:
• Be physically active
• Run that “one marathon”
• Have a pain free knee for many years

• Cell based:
• first choice for longevity and preservation
• Preserve potential biological bail out (OCA)
• Allograft:
• Second choice, possible bail out
• subchondral bone edematous or injured
• If quicker recovery to performance is necessary

=> trading safety and options for performance

• Autograft:
• Only if small (1cm2) lesion
• Beware of PF joint in a runner
• Marrow stimulation:
• In that age group will likely fail
• Can be considered for very short term gain
• “Cartilage Voodoo and pixie dust”:
• No indication in my practice due to complete lack of data

• Manage Expectations
• Be honest with your patient, particularly runners

tend to tolerate limitations

• Always think alignment
• No heroism, it will not be rewarded
• deal with disappointment before surgery rather than

after surgery

• Go for established over novel

Tha hank y you! u!