28 28 yea ear o old Basketbal all Pl Player er w with 2c 2cm - PowerPoint PPT Presentation

28 28 yea ear o old Basketbal all Pl Player er w with 2c 2cm MFC d C defec ect, st post Men eniscec ectom omy 5 5 yea ears a ago: o: “MACI is the answer” in 7 minutes Christian Lattermann, MD Professor Vice-Chair Clinical Research 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

This is Vegas and the gloves are off! • this is a totally biased presentation • I love Bill Bugbee and Kevin Bonner • Bugbee is a nice guy, but helpless when he does not have a bone plug • Bonner is a saint, no matter how hard I try, I cannot find anything on him • Just assume that I am right, because this is Plancher’s meeting and he said so!

 Activity level:  High impact sports Bissel et al, BMJ 2008  Comorbidities:  meniscectomy 5 years ago => likely tolerated well  Alignment: neutral or valgus  2cm 2 in large knee maybe a small defect

• Ideal lesion characteristics: 2-10cm 2 • Ideal age: 18-40 • Excellent track record in high level athletes This is precisely what MACI is made for and I have 10 year data to prove it! • Why would I want to violate the subchondral bone? • Why would I use a product that has no track record? • Why would I use a technique that has failed us multiple times reliably in high level athletes?

• Why destroy subchondral bone if not necessary? • Stick with the first line cellular technique that has proven short and long term outcomes equal if not better than OCA

Be real! There is no Magic! • I do not like to rely on magic and good will to address a treatable problem such as this. • Stick with what is tried and true, even if it may look less flashy and easy

• Scope needed: • No big deal, most chondral lesions require a previous scope inspection • Glued patch: • Easy handling, no sutures any longer • Small arthrotomy: • Mini-arthrotomy, enlarged portal • 30 minute surgery

Cell based: • in this case indicated and first line Allograft: • is not a first line procedure unless subchondral bone is involved Autograft: • not indicated for this size, • Donor site morbidity Marrow stimulation: • History of early failure • Microfx +: “Cartilage Voodoo”

• Manage Expectations • Avoid linear thinking • Be honest with your patient • Do not succumb to “helperism” • Be familiar with your techniques • Look at data!