Existing Treatments

Marrow Stimulation Techniques  

Microfacture/Microdrilling Technique
This technique is very similar to abrasion arthroplasty except that the bleeding is initiated by impacting awls, picks or drilling directly into the bone within the lesion.

Articular defects that are larger than 15mm in diameter are generally believed to require a more aggressive intervention and are typically treated using one of the following approaches, most of which are performed as open surgery:

Autografts

MosaicPlasty (OATS)
This technique was popularized in the mid-1990s. In MosaicPlasty, a series of dowel cutting instruments are used to harvest one or more cylindrical plugs or grafts of articular cartilage and bone from the surrounding healthy tissue. These tube-like grafts are then implanted into the defect site. A series of these plugs placed in close proximity to one another is used to establish a new grafted hyaline cartilage surface. A limited number of surgical institutions are performing this procedure as it is technically very challenging. Outcomes for these patients have been reported as variable based on surgeon expertise, and patient selection. In addition, pain relief has been found to be inconsistent. A lengthy post-operative regime of non-weight bearing (up to 2-6 months) and continuous passive motion has also been identified as a major contributor to the success of this procedure.

Autologous Cell Transplantation

ACI (Carticel^®)

ACI is a therapeutic treatment whereby healthy hyaline cartilage cells are harvested from the patient, the cell counts are increased in vitro (outside the body) via some type of bioreactor expansion technique, and then those cells are injected back into the defect. This technique is still considered somewhat experimental.

Total Knee Replacement

For patients with large articular defects a procedure known as "total knee replacement" is often required. This procedure requires the removal of substantial amounts of bone followed by the implantation of a prosthetic device. Patients who undergo TKR often describe a restoration of lifestyle/activity that is profound; however, rehabilitation periods following this procedure are several months or even longer. While the useful life of a TKR is generally claimed to be up to 20 years, clinical evidence indicates that complications can begin to arise at approximately 8 - 10 years. Each successive TKR (commonly referred to as a "revision") has been shown to have a shorter useful life than the previous implant. With each revision, the amount of remaining good quality bone stock into which the implants are anchored becomes an issue. Bone loss as a result of tissue reaction, implant loosening, implant preparation, etc., can lead to great challenges in restoring a solid anchoring site for the implant. As the revision or replacement of these devices can lead to increased morbidity (complications) and result in a very difficult rehabilitation for older patients, efforts are made to forgo the TKR procedure for as long as possible. Therefore, there is a reluctance to use TKR in patients under 60 years of age. Similar concerns and issues are prevalent in total hip replacement procedures as well. 

Resurfacing Arthroplasty

Resurfacing arthroplasty is the replacement of only the articular surface of a joint which means that only the damaged portion of the joint is resurfaced.  Therefore a smaller amount of diseased tissue is being removed when compared to a total joint.
The HemiCAP implant is a rounded, cap-like implant made from a cobalt chrome alloy with a central post on the implanted, or bone side. Cobalt chrome is a material that has been used in total joint reconstruction devices for over two decades. This material has proven to provide a safe, effective and strong weight-bearing surface in joints. The HemiCAP system precisely aligns the surface of the implant to the contours of the patient's articular cartilage surface, thus filling the defect and restores a smooth and continuous articulating surface.
Arthrosurface believes that the HemiCAP implant will offer the following clinical benefits:

• Relief from current pain and swelling
• Return to normal activity with rapid recovery time
• Restoration of a smooth, continuous, articulating load-bearing surface.
• A simple and reproducible outpatient/ambulatory surgical procedure

The McKeever Patellar Resurfacing Prosthesis (Howmedica^®), has been used in the treatment of grade III and grade IV degenerative changes in the patellofemoral joint. This anatomically shaped polished metallic patellar device was designed to maximize the area of contact with the opposed femoral articular cartilage, and differed from other non-anatomic dome-shaped designs of that time. In a series completed from 1972 to 1985, with an average of 8.1 years follow-up, excellent results were obtained in 81% of the cases. Further, no progressive degenerative changes in the opposed femoral articular cartilage associated with the prosthetic were identified over the prolonged follow-up evaluation of up to 16 years.