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AMIC technique for cartilage regeneration. Jacobi M, Jakob R.P Fribourg Switzerland. The problem. Symptoms?. Prognostic?. Treatment?. Symptoms?. 19 year old patient OCD right and left. asympomatic. symptomatic. Symptoms?. Walking time 3h. Walking time 30min. Prognostic?.

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amic technique for cartilage regeneration

AMIC technique for cartilage regeneration

Jacobi M, Jakob R.P

Fribourg

Switzerland

the problem
The problem

Symptoms?

Prognostic?

Treatment?

symptoms
Symptoms?

19 year old patient

OCD right and left

asympomatic

symptomatic

symptoms4
Symptoms?

Walking time 3h

Walking time 30min

prognostic
Prognostic?

Hunter (1743)

„From Hippocrates to the present age it is universally allowed that ulcerated cartilage is a troublesome thing and that when destroyed, it is not recovered.“

Hunter W. On the structure and diseases of articulating cartilages. Philos Trans Roy Soc. 42B:514-521, 1743

treatment
Treatment?
  • Analgetics
  • SADOA
  • Phytotherapeutics
  • Vitamin E
  • Cytokine antagonists
  • Growth factors
  • Orthokin
  • Physical therapie
  • Electrotherapie
  • Ortheses
  • Continous passiv motion
  • Lavage
  • Débridement
  • Pridie drilling
  • Laser smouthing
  • Abrasion arthroplasty
  • Spongialisation
  • Cartilage shaving
  • Microfracture technique
  • Mosaic plasty allogen
  • Mosaic plasty autologes
  • Mosaic plasty xenogen
  • Condyle transfer
  • MEGA-OATS
  • Outerbridge plasty
  • Screw fixation
  • Hemi-Arthroplasty
  • Total-Arthroplasty
  • Open wedge osteotomy
  • Closing wedge ostetomy
  • Arthrodeses
  • Autologes chondrocytes implantation (ACI) with periost flap
  • Autologes chondrocyte implantation with collagen membrane
  • AMIC
  • Autologous chondrocyte implantation 2nd generation with Scaffold of PGA, PLA, collagen, hyaloronic acid, fibrin etc. with or without chondrocytes or stem cells, autologes oder allogen with or without growth factors
  • Gore-Tex
  • Carbon fibre
  • Dacron
  • Silikon (Salucartilage)
  • Teflon implantation
  • Morselized autologous osteochondral mixture
  • Perichondrium flap
  • Periost flap
  • De novo catilage implant
  • And others...
why amic
Why AMIC
  • Analgetics
  • SADOA
  • Phytotherapeutics
  • Vitamin E
  • Cytokine antagonists
  • Growth factors
  • Orthokin
  • Physical therapie
  • Electrotherapie
  • Ortheses
  • Continous passiv motion
  • Lavage
  • Débridement
  • Pridie drilling
  • Laser smouthing
  • Abrasion arthroplasty
  • Spongialisation
  • Cartilage shaving
  • Microfracture technique
  • Mosaic plasty allogen
  • Mosaic plasty autologes
  • Mosaic plasty xenogen
  • Condyle transfer
  • MEGA-OATS
  • Outerbridge plasty
  • Screw fixation
  • Hemi-Arthroplasty
  • Total-Arthroplasty
  • Open wedge osteotomy
  • Closing wedge ostetomy
  • Arthrodeses
  • Autologes chondrocytes implantation (ACI) with periost flap
  • Autologes chondrocyte implantation with collagen membrane
  • AMIC
  • Autologous chondrocyte implantation 2nd generation with Scaffold of PGA, PLA, collagen, hyaloronic acid, fibrin etc. with or without chondrocytes or stem cells, autologes oder allogen with or without growth factors
  • Gore-Tex
  • Carbon fibre
  • Dacron
  • Silikon (Salucartilage)
  • Teflon implantation
  • Morselized autologous osteochondral mixture
  • Perichondrium flap
  • Periost flap
  • De novo catilage implant
  • And others...
what means amic
What means AMIC

Autologous Membrane

Induced Chondrogenesis

(Behrens 2001)

slide10
Case
  • 36 year old male
  • Status 17y after partial medial meniscectomy
  • 2y ago, hyperextension injury with full thickness medial condylar cartilage injury
step 3 covering the defect with chondro gide membrane
Step 3: Covering the defect with Chondro-Gide® membrane

Matrix cut to the size and sutured to the defect with 5-0 PDS

step 4 injection of serum and opening of the tourniquet
Step 4: Injection of Serum and opening of the tourniquet

Meanwhile the serum of the patient is mixed with the thrombin of which half the thrombin has been discarded (Behrens, AMIC)

step 5 extension and flexion of the knee
Step 5: Extension and Flexion of the knee

Blood and fibrin glue have expanded the matrix

rehabilitation
Rehabilitation
  • No motion of the knee for 7-10 days followed by Kinetec
  • Crutch walking for 10 weeks until osteotomy is healed and the defect is filled
why amic20
Why AMIC?
  • Single stage procedure
  • Coasts are moderate
  • Chondro-Gide® provides a matrix to form fibrocartilage
  • it protects and stabilizes the blood clot
  • it prevents bleeding into the joint
  • No donor site morbidity
  • No cell culture
slide21
But...
  • We always check the mechanical alignement with full leg radiographs or a CT for femoropatellar problems
  • We are very generous to perform an additional osteotomy
j orthop res 2000 18 781
J. Orthop. Res. 2000;18:781
  • HEALING OF CANINE ARTICULAR CARTILAGE DEFECTS TREATED WITH MICROFRACTURE, A TYPE II COLLAGEN MATRIX, OR CULTURED AUTOLOGOUS CHONDROCYTES
  • H.A. Breinan, Hu-Ping Hsu,
  • Scott Martin, and Myron Spector
slide24

Type II collagen-GAG scaffold

Geistlich Biomaterials

Trochlear Groove

HA Breinan, et al. J . Orthop. Res. 2000;18:781

slide25

Hyaline

Fibrocart.

Fibrous

Total fill

100

100

80

75

60

50

40

25

20

0

0

µfx

µfx/II

µfx

µfx/II

15 Wks Post-op., n=8, Mean ± SEM

%

%

HA Breinan, et al. JOR 2000;18:781

slide26

Microfracture-Treated Defects, 15 weeks post-op

Adjacent articular cartilage

Defect

Microfracture alone

Defect

Adjacent articular cartilage

Microfracture plus a type II collagen implant

HA Breinan, et al. JOR 2000;18:781

total 42 cases of amic procedures 2003 2006

Total 42 cases of AMIC procedures(2003-2006)

indications
Indications
  • Femoropatellar joint 21
  • Femoral lesion 6
  • Femoral OCD lesion 9
  • Talar OCD lesion 6

Total42

failures
Failures
  • Femoropatellar joint 21 -> 0
  • Femoral lesion 6 -> 1
  • Femoral OCD lesion 9 -> 2
  • Talar OCD lesion 6 -> 0

Total42 -> 3

failures31
Failures
  • 1 Femoral lesion III° not debrided to a IV° lesion
  • 2 OCD lesions without sufficient debridement
  • All other cases have a sactisfactory result (6-30 month follow-up)
case 2
Case 2
  • 44y old female
  • Obesity 120kg
  • Femoropatellar pain
  • VAS (0-10) 9
  • Walking time 15 min
slide36

Patella

Trochlea

additional surgery
Additional surgery
  • Coverage of trochlea with Periost Cambium down
  • Slight medialisation and ventralisation of tuberosity
  • Lateral release
result
Result

1 year

2 year

Preoperative

  • VAS (0-10) 2-3
  • Walking 2 hours possible
case 3 ocd cangoroo method
Case 3: OCDCangoroo method
  • 44 year old male
  • Large Osteochondral Defect on medial femoral condyle
4 weeks later
4 weeks later

Abrasion and microfracturing

conlusion
Conlusion
  • In summary this new method of instant coverage is interesting because it is readily available and economic. Whether it will offer good enough a cartilage regenerate we shall see. But for OCD, which is mainly a problem of the bone, it offers a valid alternative.
  • Sometimes we can create a decent fibrocartilage with hyaline like components.
slide55
As probably all methods, it does not tolerate mechanical overload due to an unfavorable mechanical axial alignment. We therefore are very generous with alignment correction.
  • A radical debridement is always necessary
thank you
Thank you

Hôpital cantonal Fribourg