Revisiting microfracture Lisa A. Fortier, DVM, PhD, DACVS James Law - PowerPoint PPT Presentation

Cornell University College of Veterinary Medicine Revisiting microfracture Lisa A. Fortier, DVM, PhD, DACVS James Law Professor of Surgery laf4@cornell.edu

Disclosures • Consultant: Arthrex, Veterinary Recommended Nutraceuticals, TissueGen • Royalties: Arthrex • Scientific Board: Kensey Nash

Available tools Economic and regulatory realities • 2 stage – ACI (1995), MACI (2016) • Single stage – Microfracture • Put down your awl – Microfracture plus • BMAC, BioCartilage, DeNovo, Cartiform, etc. • Mechanical mini abrasion arthroplasty 3

Theory vs reality Fortier JKS 2013

Cartilage & bone affected! Fortier, AJSM 2016 2 months surface view 6 months 13 months saggital

Burn no bridges moderate echo time FSE A: subchondral bone B: cartilage C: fibrocartilage D: subchondral sclerosis Central osteophyte Fat supressed spoil gradient MRI Courtesy, T Mosher Courtesy, John Kennedy McIlwraith, Arthroscopy 2011

Put down your (conventional) awl! AJSM 2009

Awl of them Gianakos Arthroscopy 2016 Small is better, but damage inevitable

What really matters? Prepare the defect walls Remove calcified cartilage mini abrasion arthroplasty to bleeding Arthroscopic Cobb Elevator

Available tools Future • Small/slow drill, hollow awl? • Microfracture plus – BMAC, BioCartialge, DeNovo, Cartiform, etc. Min, Arthroscopy 2017 Fortier JBJS 2010 Chu JBJS 2017 • Mini mechanical abrasion arthroplasty 10

Acknowledgements