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Speaker lauds progress in cartilage repair field, but calls for more cost data, better diagnosis
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TORONTO — More than 2 decades after a handful of promising new cartilage treatments were first used clinically, the field of cartilage repair is ready for new advances. Orthopedic sports medicine surgeons should lead the charge forward, even as longer-term results with the currently used treatments for articular cartilage lesions are awaited, according to a presenter, here.
At the American Orthopaedic Society for Sports Medicine Annual Meeting, Christian Lattermann, MD, said the randomized controlled trials into cartilage repair techniques, such as as microfracture (MFX), autologous chondrocyte implantation (ACI) in all its forms, osteochondral allograft transplantation (OAT) and others, will ultimately provide information to help refine the indications for and improve results with these procedures.
“Randomized controlled trials, at this point, are the standard now and that’s a huge step forward,” he said.
He noted there are a handful of recently published “robust” large registry studies, such as one into ACI by Tom Minas, MD, and colleagues in 2014 and another by William D. Bugbee, MD, and colleagues in 2013 that evaluated OAT, that will contribute valuable findings. Among what is expected to come out of these investigations are data about cost-effectiveness and clearer results with each technique that orthopedic surgeons can convey to their patients and use to guide treatment decisions, Lattermann explained.
For example, “Prior procedures, we have shown, do have an effect on subchondral bone and on the overall outcome,” he said.
“Subchondral bone violation is not benign. Malalignment and tissue loss is important.”
Lattermann asked, “So, have we made progress? I think we have made substantial progress in this field. This is one of the few areas in orthopedics, actually, where we have been able to gradually climb up the ladder of evidence. Currently available technology that we have, with evidence, is old but true.”
Some new techniques and materials, such as microfracture plus which is performed to treat larger cartilage lesions and includes the addition of a scaffold to traditional microfracture, are in the works, Lattermann said.
“Economics of cartilage healing, better understanding of the actual underlying diagnosis — that’s what’s coming up for us,” he said. – by Susan M. Rapp
Reference:
Lattermann C. Have we made progress in cartilage repair, and what’s on the frontier? Presented at: American Orthopaedic Society for Sports Medicine Annual Meeting; July 20-23, 2017; Toronto.
Disclosure: Lattermann reports Vericel, Cartiheal, Orteq make payments to Kentucky Medical Society Foundation, not him, and he receives research support from Smith & Nephew Endoscopy.