CARTICEL® Case Studies

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CARTICEL Case Studies
Bennett Orthopedics Sportsmedicine Regeneratin
g the Youth in You! William F Bennett
MD Orthopedic Surgeon
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Case Study TemplatePatient Description

• Age
• Gender
• Date of knee injury
• Symptoms
• Previous surgery (s)
• List of co-morbidities (if any)
• Joint stability
• Alignment
• Meniscal pathology
• Employment activities of relevance
• Patient expectations (what do they want to return
  to?)

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Case Study TemplateClinical Results

• Improvement in Symptoms
• Level of Activity
• Activities of daily living
• Return to sports and recreation
• Limitations
• Second Look Images (if any)

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CARTICEL Case Study 1

• 31 year-old male Air Force mechanic.
• Recreational basketball player.
• Acute basketball injury occurring in June 2004.
• Patient presented patello-femoral instability of
  the left knee.
• Patient desires to return to sports activities.

Case study and images courtesy of Jason M. Scopp,
MD. Salisbury, MD.
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CARTICEL Case Study 1Clinical Findings

• Pre-operative findings
• X-ray revealed normal joint space and patella
  orientation.
• Patient stated during the H P that he
  dislocated his knee cap while playing
  basketball.
• Arthroscopic Evaluation
• 2.0 cm X 2.0 cm (4.0 cm2) trochlear defect on
  the left knee treated with chondroplasty, which
  subsequently failed.
• Confirmed lateral subluxation of patella.
• Biopsy taken for CARTICEL implantation.

Case study and images courtesy of Jason M. Scopp,
MD. Salisbury, MD.
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CARTICEL Case Study 1Implantation

• CARTICEL implantation occurred after patient
  failed to respond to initial chondroplasty.
• Following tibial tubercle osteotomy (Fulkerson)
  cut to correct lateral subluxation, the patella
  was reflected, exposing the trochlea defect.
• CARTICEL was implanted and periosteal patch was
  sewn into place.

Case study and images courtesy of Jason M. Scopp,
MD. Salisbury, MD.
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CARTICEL Case Study 1Clinical Results

• Second-Look Arthroscopy
• Underwent a second look arthroscopy 9 months
  after implantation when patient re-injured knee
  (patients son bumped into the knee).
• Integrated, restored cartilage congruent with
  joint surface of the trochlea.
• Clinical Outcome
• Patient completed rehabilitation program,
  returned to work and recreational sports, and
  continues to play basketball regularly.
• Patient does not have any limitation with regards
  to desired level of activity.

Case study and images courtesy of Jason M. Scopp,
MD. Salisbury, MD.
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CARTICEL Case Study 2

• 35 year-old male assembly line worker
• Recreational basketball player and high school
  football coach
• Sustained injury while playing basketball in
  April of 2005
• Patient presented with pain, edema and
  instability in the right knee.
• Patient desires to return to sports activities.

Case study and images courtesy of Akbar Nawab,
MD. Louisville, KY.
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CARTICEL Case Study 2Clinical Findings

• Co-Morbidities
• Pre-operative MRI revealed a complete ACL tear,
  medial and lateral meniscus tears, all which were
  repaired at the time of initial arthroscopy.
• No malalignment.

Case study and images courtesy of Akbar Nawab,
MD. Louisville, KY.
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CARTICEL Case Study 2Clinical Findings

• Initial arthroscopy
• Large 8.75 cm2 (2.5 cm X 3.5 cm) MFC lesion with
  detached cartilage segment.
• Lesion was treated with debridement, which
  subsequently failed.
• Detached articular cartilage segment in
  interchondylar notch was removed.
• Biopsy taken for CARTICEL implantation.
• ACL was reconstructed and menisci were repaired
  at this time.

Case study and images courtesy of Akbar Nawab,
MD. Louisville, KY.
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CARTICEL Case Study 2Implantation

• CARTICEL Implantation occurred after patient
  failed to respond to initial debridement.

MFC defect after debridement.
Periosteal harvest from tibia.
MFC defect post-implantation.
Case study and images courtesy of Akbar Nawab,
MD. Louisville, KY.
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CARTICEL Case Study 2Clinical Results

• Second-Look Arthroscopy
• Arthroscopic evaluation 22 months post CARTICEL
  implantation.
• Loose meniscal suture anchor was removed.
• Meniscus tear healed and ACL was stable.
• Integrated, restored cartilage congruent with
  joint surface of the MFC.
• Clinical Outcome
• Patient completed rehabilitation program and
  resumed work as assembly line laborer.
• Full return to playing basketball and coaching
  football.
• No complaints of instability.
• No pain after loose anchor removal.

Integrated MFC with no hypertrophy or
delamination
Case study and images courtesy of Akbar Nawab, MD
Case study and images courtesy of Akbar Nawab,
MD. Louisville, KY.
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Important Treatment Considerations

• CARTICEL is for autologous use and is indicated
  for the repair of symptomatic cartilage defects
  of the femoral condyle (medial, lateral or
  trochlea), caused by acute or repetitive trauma,
  in patients who have had an inadequate response
  to a prior arthroscopic or other surgical repair
  procedure (e.g., debridement, microfracture,
  drilling/abrasion arthroplasty, or osteochondral
  allograft/autograft). CARTICEL should only be
  used in conjunction with debridement, placement
  of a periosteal flap and rehabilitation. The
  independent contributions of the autologous
  cultured chondrocytes and other components of the
  therapy to outcome are unknown. It is not
  indicated for the treatment of cartilage damage
  associated with generalized osteoarthritis. It is
  not recommended for patients whose knee meniscus
  has been surgically removed unless the patient
  has undergone surgical reconstruction prior to or
  concurrent with CARTICEL implantation.
• Pre-existing conditions including meniscal tears,
  joint instability or malalignment of the joint
  should be corrected prior to or concurrent with
  CARTICEL implantation. It should not be used in
  patients with a known history of hypersensitivity
  to gentamicin, other aminoglycosides or materials
  of bovine origin. CARTICEL is not routinely
  tested for transmissible infectious diseases and
  may transmit disease to the healthcare provider
  handling CARTICEL. In addition, it should not be
  used in patients who have previously had cancer
  in the bones, cartilage, fat or muscle of the
  treated limb. Use in children, patients over age
  65, or in joints other than the knee has not yet
  been assessed.
• The occurrence of subsequent surgical procedures
  (SSPs), primarily arthroscopy, following CARTICEL
  implantation is common. In the Study of the
  Treatment of Articular Repair (STAR), forty-nine
  percent (49) of patients underwent an SSP on the
  treated knee, irrespective of their relationship
  to CARTICEL, during the 4-year follow-up. The
  most common serious adverse events (5 of
  patients), derived from STAR, include
  arthrofibrosis/joint adhesions, graft overgrowth,
  chondromalacia or chondrosis, cartilage injury,
  graft complication, meniscal lesion, graft
  delamination, and osteoarthritis.