2021 ISAKOS Biennial Congress Paper
Novel Solution Using Viable Cartilage Allograft For Focal Cartilage Defects
Deryk G. Jones, MD, Jefferson, LA UNITED STATES
Bhumit Desai, MD UNITED STATES
Emmanuel Koli, MD, New Orleans, Louisiana UNITED STATES
Michael Warren, MD, New Orleans, LA UNITED STATES
Gerard Karl Williams Jr., MD, Takoma Park, Maryland UNITED STATES
Graylin Jacobs, CRC, New Orleans, Louisiana UNITED STATES
Walter Stephen Choate, MD, New Orleans, Louisiana UNITED STATES
Scott C Montgomery, MD, New Orleans, LA UNITED STATES
Misty Suri, MD, New Orleans, LA UNITED STATES
Ochsner Sports Medicine Institute, New Orleans, Louisiana, UNITED STATES
FDA Status Cleared
Summary
Clinical studies show VCA can safely treat chondral defects with potential advantages to existing options.
Abstract
Background
Viable Cartilage Allograft (VCA) contains cryopreserved viable allogeneic cartilage fibers mixed with chondrogenic matrix. In-vitro and animal studies and a prospective case series were completed with VCA to assess safety and benefits in treating focal knee cartilage defects. Our hypothesis is that VCA is a safe single stage procedure in isolated chondral defects with results comparable or better than other single stage procedures.
Methods
Cell viability and functionality of VCA was evaluated in-vitro. VCA was also evaluated in a goat cartilage repair model. 19 patients (7/12 M/F) were implanted, mean age 26.77 (15-56), mean BMI 27.59 ± 6.1, mean follow-up 19 months (range 12.0–26.3 months). Symptomatic International Cartilage Repair Society (ICRS) grade 3 / 4A lesions of the femoral condyle (n=4) or patella (n=14) were treated. Lesion sizes ranged from 1.4-6.0 cm2 (mean defect size was 5.025 cm2). International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome (KOOS) subscales, Lysholm, Short Form-12 (SF-12), visual analog scale (VAS) and pain frequency levels were assessed. Radiographs and magnetic resonance imaging (MRI) were performed at 3 and 6 months (M).
Results
In vitro assessment confirmed VCA contains viable and functional chondrocytes. The goat study confirmed VCA is effective for cartilage repair. Lysholm (25.3), KOOS: Pain (12.2), Symptoms (19.6), ADLs (14.5), Sports (13.7), and QOL (28.9) at 6 months increased from pre-operative baseline (POB) and were maintained at 12 months: IKDC (72.2), Lysholm (84.2), KOOS: Pain (87.8), Symptoms (80.7), ADL (97.6), Sports (72), and QOL (61.2). MRI imaging at 6 and 12 months showed viable preliminary cartilage tissue with no significant bone edema or graft delamination. Second look arthroscopy (2 patients) demonstrated complete fill and incorporation (Brittberg Scores 11/12). Functional scores improved at 24(M): IKDC (87.3), Lysholm (87.7), KOOS: Pain (92.5), Symptoms (86.2), ADLs (95.6), Sports (82.9), QOL (82.1).
Conclusion
VCA is an off-the-shelf, single stage, conformable allogeneic graft that treats chondral defects with no additional fixation. Pre-clinical and short-term prospective clinical studies show VCA can safely treat chondral defects with potential advantages to existing options.