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LESS current treatment of cartilage defects

http://www.frankmccormickmd.com/ Dr. Frank McCorimck is an orthopedic surgeon serving the greater Miami and Fort Lauderdale area. A navy vet and Harvard-trained, Dr. McCormick specializes in sports medicine, arthroscopic surgery, biologic joint preservation, and cartilage failure treatments.

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LESS current treatment of cartilage defects

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  1. Current Concepts for Cartilage Defect Treatment Options Frank McCormick M.D Samuel Rosas MSIV www.FrankMcCormickMD.com LESS Surgical Institute Shoulder and Sports Division Miami/Fort Lauderdale/Boca Raton/West Palm Beach/ Orlando

  2. Agenda 1. Cartilage physiology Cartilage defects 2. Epidemiology 3. Current Modalities of treatment 4. Future of cartilage injury treatment 5. Summary and Questions 6.

  3. Cartilage Physiology

  4. Epidemiology • 66% of patients had a cartilage defect • N= 993 • 11% full thickness pathology • Athletic population: • N= 993 • 36% full thickness lesion • 2 Million Ankle sprains per yea. 50% likely result in a chondral defect

  5. Diagnosis

  6. Why treat?

  7. Summary of treatment options 1. Conservative treatment 2. Micro-fracture 3. Autologous Chondrocyte Implantation 4. Biological Approach 5. Different Graft options

  8. G. Bentley et al. / Injury, Int. J. Care Injured 44 (2013) S3–S10

  9. Conservative Management NSAIDS Physical therapy Chondritin Sulfate Activity Modification

  10. Microfracture -Bone marrow stimulation technique -Can be done arthroscopically -No additional cost to the procedure -No difference vs OAT vschondroplasty in 32 patients at mean follow up period of 33 months. -Best for small defects: less than 15mm -Great option for competitive athlete who needs quick recovery -Beyond 5 years, treatment failure may be expected

  11. Osteochondral allograft transplantation • -Using a transplant from a fresh cadaver • -Used for larger defects • -Bacterial and PCR testing must be done first • -transplant intact cartilage and bone • -Only available in US

  12. Autologous Chondrocyte Implantation ACI

  13. Biological approach Platelet rich plasma = PRP -More than 800 proteins -More than 1.500 bioactive factors -Ex: Ca, IL, ADP, ATP, AA, Histamine, 5HT, Dopamine, IGF-1, TGF-B, HGH… Adding PRP to MSC increased differentiation when in a chondrocyte medium

  14. Stem Cells -New development -Research under way -Different types

  15. Combination therapy

  16. Questions, comments, concerns? www.frankmccormickmd.com drfrankmccormick@yahoo.com Online Appointments available at zocdoc.com

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