SCOI ACI/MACI Where Are We At? SCOI ACI/MACI The following - - PowerPoint PPT Presentation

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Oct 29, 2022 158 likes •456 views

SCOI ACI/MACI Where Are We At? SCOI ACI/MACI The following relations exists Royalties and stock options Smith and Nephew, Wolters Kluwer Consulting income Smith and Nephew, Geistlich, Ossur, Cannuflow Research and educational

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ACI/MACI

Where Are We At?

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ACI/MACI

The following relations exists

Royalties and stock options – Smith and Nephew, Wolters Kluwer Consulting income – Smith and Nephew, Geistlich, Ossur, Cannuflow Research and educational support – Mitek, Smith & Nephew & Arthrex

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Treatment Options for Cartilage Defects

< 1 cm2

Debridement Drilling MicroFracture

2.5 - 4 cm2

Drilling Osteochondral Transplants ACI Allografts Juvenile Allografts Micronized Cartilage Matrix Focal Resurfacing Replacement

1 - 2.5 cm2

Debridement Drilling MicroFracture Osteochondral Transplants ACI Allografts Juvenile Allografts Micronized Cartilage Focal Resurfacing Replacement

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Indications for ACI in the Ankle

Patients Aged 15 – 55 Focal Defect > 1 cm2 Unipolar (Only Talus) Contained Edge Loading Failed Previous Surgery Large Lesions with Subchondral Cystic Changes in Primary Cases

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ACI – MM Osteotomy

Incision Over Medial Malleolus and Expose Anterior & Posterior Avoid Injury to N-V Structures & Tendons Using Fluro, Place Guide Pin over Bone at Correct Osteotomy Site and Mark with Methylene Blue Predrill Two Oblique Cannulated Screw Holes Prior to Osteotomy

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Use Guide Pin & Fluro to Mark Osteotomy Osteotomy Plane Orientated to Allow Two Interfrag. Screws + Plate & Exits at Syndesmosis Pre-Drill Interfrag. Screw Holes

Technique for OFO

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Chondro-Gide

Chondro-Gide is a Porcine Type I/III Collagen Membrane (Matrix) Bilayer Matrix With One Compact (Smooth) and One Porous Surface Membrane Takes the Place of Periosteum Used for ACI-C (CACI) and AMIC as a Patch Sold in USA as Bio-Gide Currently Being Used Instead of Periosteum

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Bio-Gide Collagen Membrane

Type I/III Bilayer Porcine Collagen Membrane Gomoll et al. Compared Subsequent Surgeries After ACI-P & ACI-C (Bio-Gide) in Knee Results Similar Except Hypertrophy Related Surgery ACI –P = 26% ACI-C = 5.0%

AJSM 37:20S, 2009

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ACI – Defect Preparation

Incise Lesion Vertically and Remove All Damaged Cartilage From Subchondral Bone Make 90º, Sharp Walls B/N Defect and Healthy Cartilage

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ACI Membrane Implantation

Membrane is Implanted and Secured With 6-0 Vicryl to OLT Bed Fibrin Glue is Used to Seal the Membrane “Water Tight” Except a Hole is Left for Cell Insertion

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ACI Cell Implantation

Insert Catheter Through Opening in Membrane Slowly Inject Cells Suture Remaining Hole in Membrane Seal Hole With Fibrin Glue

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ACI “Sandwich” Bone Grafting

CYST

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Rehabilitation

Initially Short Leg Cast NWB At Two Weeks, Stitches Out and Start 30lbs WB In CAM Boot for 4 Weeks At Six Weeks, Progress to FWB and Start Phase I P.T.

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ACI Results - Ferkel (2014)

32 Patients Total

Male = 16; Female = 16 Medial = 24; Lateral = 8 32/32 = Previous Surgery Current Study: F/U 29/32 = 91%

Ave. Age = 34 (18-54)
Ave. F/U = 70 Mos (24-129)

“Sandwich” Procedures = 9 2nd Look = 90% (26/29)

Excell. = 8, Good = 15, Fair = 5

Poor = 1

AJSM, 42:2156, 2014

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ACI Results in Ankle

Giannini et al. (2014) Developed an Arthroscopic ACI Procedure 46 pts. Had the Procedure With Mean Age = 31 Mean Follow up: 7 + 1.2 yrs Pre-op AOFAS = 57, Post-op AOFAS = 92 Failures = 3

KSSTA 22:1311, 2014

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ACI - Pearls

Adequate Osteotomy Excise All Diseased Tissue Bone Graft Deep Cysts When Suturing Periosteum/Membrane, Grasp 4-5 mm Into Normal Cartilage Seal Graft Completely Correct Associated Instability Rigid Fixation of Osteotomy

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MACI Scaffold

Matrix Induced ACI Biocomposite With Highly Purified Bioresorbable Type I-III Collagen Membrane Supporting ACI Launched in 2000 in Europe and Australia with 3200 Pts Treated Vericel Acquired Genzyme & is Developing MACI in US

Courtesy of Eric Giza, MD

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MACI Scaffold

Remove Osteochondral Lesion Size Defect Apply MACI with Fibrin Glue

Courtesy of Prof. Pedro Guillen Garcia

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MACI Case Study

37 y/o Female Who Suffered FX-

Disl. Left Ankle During Roller

Derby Match on 9-1-14 She Had ORIF by PMD and Healed With Pain OLT Noted and Scope Debridement and MicroFX by PMD Without Help 8-2015 Pt Had Scope Knee & Ankle + ACI Biopsy MACI Was Done With Excision of OLT & Cyst. ICBG Insert With Sandwich Procedure = MACI

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MACI Case Study – Pre op CT

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MACI Case Study

1 2 3 4 5 6

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MACI Case Study

7 8 9 10 11 12

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MACI Case Study

13 14 15 16 17 18 19 20 21

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MACI

Aurich et al (2011) – Studied 18 Pts With Scope MACI Used Arthrometrix Woven Tissue SCORES Pre Post

FFI Pain 5.5 2.8 FFI Disability 5.0 2.6 AOFAS 59 80

Excellent – Good 64% 81% Returned to Sports

AJSM 39:311, 2011

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OLT Ankle - Summary

Newer Technology Shows Positive Early Results But More Cases With Longer F/U Needed

Max. Clinical & Histological

Results at 24 mos. Or Longer Future – Scaffolds, Stems Cells, Growth Factors, ? Solution is Within Our Grasp and Must Be Done Arthroscopically Stepwise Evolution of Concepts and Science

Cartilage Solution

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ACI/MACI Treatment

International Consensus Meeting

n Cartilage Repair of the Ankle

Nov 17-18, 2017, Pittsburgh, PA

Significant Recommendations for Treatment of OLTs Publications Coming Early 2018

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T H A N K

ACI/MACI

Where Are We At?

Y O U