S. Sherman (Redwood City, US)
Stanford Medicine Orthopaedic SurgeryPresenter Of 5 Presentations
Moderator Introduction
7.2.2 - Patient Specific Instrumentation for HTO and DFO: Presentation and Key Points of the Surgical Techniques
9.1.2 - Pivotal Study Results: Agili-C™ vs. Microfracture and Debridement for the Treatment of Joint Surface Lesions
10.1.3 - Presence of Mild-Moderate Knee Osteoarthritis Does Not Affect the Clinical Outcome Using an Aragonite-Based Implant
Abstract
Purpose
OA has been considered a contra-indication for cartilage regenerative procedures. The objective of this study is to present the outcome following implantation of an aragonite-based implant (Agili-C™, CartiHeal Ltd, Israel) for the treatment of chondral/osteochondral defects in subjects with or without knee osteoarthritis (OA).
Methods and Materials
251 subjects suffering from knee chondral/osteochondral defects, with different grades of concurrent knee OA (Kellgren Lawrence score 0-3), were treated in a large multicenter, randomized, controlled trial: 167 subjects received the aragonite-based implant, and 84 subjects were treated by debridement/microfracture (control group). Clinical evaluation was performed using the KOOS score at 6, 12, 18 and 24 months. Subjects were stratified according to the grade of joint degeneration: none or minimal OA (K/L 0-1) vs. mild or moderate OA (K/L2-3). Results were then compared to assess whether the OA grade had an impact on the clinical outcome and to identify difference in performance between the implant and control group.
Results
In the implant group, 91 subjects had K/L 0-1, whereas 76 had K/L 2-3. At 6 months, the overall increase in KOOS score from baseline was 27.5 and 27.6 points respectively, well beyond the MCID. At the final 24 month follow-up, the increase was 43.9 points in K/L 0-1 and 41.9 points in K/L 2-3, without significant difference between these subgroups. Conversely, in the control group, the increase at 24 months was significantly lower: 23.2 points in K/L 0-1 subjects and 19 points in K/L 2-3 subjects. The scaffold group showed, therefore, superior outcome (p<0.0001), with a positive clinical trend throughout the entire study period.
Conclusion
The presence of mild-moderate OA did not impact the efficacy of the aragonite-based implant, which was able to provide significant clinical benefit even in patients with mild-moderate OA.
16.3.8 - Risk for Failure After Index Osteochondral Allograft Transplantation: An Analysis of 1428 Cases
Abstract
Purpose
Osteochondral allograft transplantation has a demonstrated survivorship of upwards of 90% in the first five years following surgery. Although OCAs are highly effective, in some cases, subsequent surgeries may be required. There is currently limited data on the risk factors for reoperations following OCA and the interventions ultimately required. The purpose of this study was to utilize a large insurance database to evaluate the risk factors for failure within five years of OCA transplantation.
Methods and Materials
We queried the MarketScan database from 2007-2015 to identify patients who underwent primary OCA. Patients with previous ipsilateral anterior cruciate ligament reconstruction or meniscus surgery were excluded. Baseline demographic data and patient co-morbidities were documented. Failure of OCA, which we defined as ipsilateral revision OCA or conversion to unicomparmental or total knee arthroplasty, was documented through 5-years following index OCA. Multivariate regression analyses were conducted to identify risk factors for failure.
Results
A total of 1428 patients were included in the study. Mean age of the cohort was 31.6 years (SD 12.1) with 41.2% of the cohort being female. 9.7% of the cohort was obese at the time of initial OCA, 7.5% were active smokers, and 15.5% of the cohort had a previous cartilage restoring procedure. 0.3% underwent a revision or arthroplasty procedure within 5-years. Female sex (OR 1.61) and a history of microfracture prior to OCA (OR 1.21) increased risk for OCA failure. Concomitant osteotomy at the time of index OCA decreased odds of failure (OR 0.4, p – 0.0366).
Conclusion
Female sex and a history of microfracture increased odds for OCA failure, whereas a concomitant osteotomy at time of index surgery improved survivorship. This data should factor into a surgeon’s decision making when considering OCA for their patients with chondral defects of the knee.
Moderator Of 4 Sessions
- K. Wong (Singapore, SG)
- Y. Lee (Singapore, SG)
- T. Lazzaretti (São Paulo, BR)
- J. Calcei (Cleveland, US)
- F. Attar (Altrincham, GB)
- L. Tirico (Sao Paulo, BR)
- T. Piontek (Poznan, PL)
- B. Di Matteo (Rozzano Milano, IT)
- R. Grabowski (Lodz, PL)
- V. Muthukumar (Chennai, IN)
- J. Chahla (Chicago, US)
- C. Lee (Sacramento, US)
- In this instructional course, participants will learn how to write a successful grant application.
Meeting Participant Of
- D. Saris (Rochester, US)
- T. Minas (West Palm Beach, US)
- E. Kon (Milano, IT)
- C. Lattermann (Boston, US)
- A. Gobbi (Milano, IT)
- D. Grande (Manhasset, US)
- S. Marlovits (Vienna, AT)
- M. Brittberg (Kungsbacka, SE)
- W. Bugbee (La Jolla, US)
- J. Lane (La Jolla, US)
- C. Erggelet (Zürich, CH)
- A. Krych (Rochester, US)
- F. Sciarretta (Rome, IT)
- S. Sherman (Redwood City, US)
- M. McNicholas (Liverpool, GB)
- S. Nehrer (Krems, AT)
- F. Villalobos Córdova (Mexico City, MX)
- M. Lipina (Moscow, RU)
- M. Iosifidis (Thessaloniki, GR)
- B. Di Matteo (Rozzano Milano, IT)
- S. Sherman (Redwood City, US)
- J. Lane (La Jolla, US)
- L. Tirico (Sao Paulo, BR)
- F. Taraballi (Houston, US)
- F. Vannini (Bologna, IT)
- M. Hussein (Ljubljana, SI)
- G. Whyte (New York, US)
- D. Turgeon (Shreveport, US)
- S. Görtz (Newton, US)
- S. Sherman (Redwood City, US)
- F. Sciarretta (Rome, IT)
- S. Nehrer (Krems, AT)
- M. McNicholas (Liverpool, GB)
- S. Marlovits (Vienna, AT)
- B. Mandelbaum (Santa Monica, US)
- J. Lane (La Jolla, US)
- A. Krych (Rochester, US)
- C. Erggelet (Zürich, CH)
- M. Brittberg (Kungsbacka, SE)
- W. Bugbee (La Jolla, US)
- A. Gobbi (Milano, IT)
- D. Grande (Manhasset, US)
- C. Lattermann (Boston, US)
- E. Kon (Milano, IT)
- T. Minas (West Palm Beach, US)