AMIC method for ligament recovery

Presentation Transcript

AMIC system for ligament recovery Jacobi M, Jakob R.P Fribourg Switzerland

The issue Symptoms? Prognostic? Treatment?

Symptoms? 19 year old patient OCD right and left asympomatic symptomatic

Symptoms? Strolling time 3h Walking time 30min

Prognostic? Seeker (1743) „From Hippocrates to the present age it is generally permitted that ulcerated ligament is a troublesome thing and that when obliterated, it is not recouped." Hunter W. On the structure and maladies of articulating ligaments. Philos Trans Roy Soc. 42B:514-521, 1743

Treatment? Analgetics SADOA Phytotherapeutics Vitamin E Cytokine rivals Growth components Orthokin Physical therapie Electrotherapie Ortheses Continous passiv movement Lavage Débridement Pridie boring Laser smouthing Abrasion arthroplasty Spongialisation Cartilage shaving Microfracture strategy Mosaic plasty allogen Mosaic plasty autologes Mosaic plasty xenogen Condyle exchange MEGA-OATS Outerbridge plasty Screw obsession Hemi-Arthroplasty Total-Arthroplasty Open wedge osteotomy Closing wedge ostetomy Arthrodeses Autologes chondrocytes implantation (ACI) with periost fold Autologes chondrocyte implantation with collagen film AMIC Autologous chondrocyte implantation second era with Scaffold of PGA, PLA, collagen, hyaloronic corrosive, fibrin and so forth with or without chondrocytes or foundational microorganisms, autologes oder allogen with or without development elements Gore-Tex Carbon fibre Dacron Silikon (Salucartilage) Teflon implantation Morselized autologous osteochondral blend Perichondrium fold Periost fold De novo catilage embed And others...

Why AMIC Analgetics SADOA Phytotherapeutics Vitamin E Cytokine enemies Growth components Orthokin Physical therapie Electrotherapie Ortheses Continous passiv movement Lavage Débridement Pridie boring Laser smouthing Abrasion arthroplasty Spongialisation Cartilage shaving Microfracture method Mosaic plasty allogen Mosaic plasty autologes Mosaic plasty xenogen Condyle exchange MEGA-OATS Outerbridge plasty Screw obsession Hemi-Arthroplasty Total-Arthroplasty Open wedge osteotomy Closing wedge ostetomy Arthrodeses Autologes chondrocytes implantation (ACI) with periost fold Autologes chondrocyte implantation with collagen film AMIC Autologous chondrocyte implantation second era with Scaffold of PGA, PLA, collagen, hyaloronic corrosive, fibrin and so forth with or without chondrocytes or undeveloped cells, autologes oder allogen with or without development variables Gore-Tex Carbon fibre Dacron Silikon (Salucartilage) Teflon implantation Morselized autologous osteochondral blend Perichondrium fold Periost fold De novo catilage embed And others...

What implies AMIC An utologous M embrane I nduced C hondrogenesis (Behrens 2001)

Case 36 year old male Status 17y after fractional average meniscectomy 2y prior, hyperextension damage with full thickness average condylar ligament harm

Step 1: Osteotomy

Step 2: Abrasion Chondroplasty and Microfracture

Step 3: Covering the deformity with Chondro-Gide ® layer Matrix slice to the size and sutured to the imperfection with 5-0 PDS

Step 4: Injection of Serum and opening of the tourniquet Meanwhile the serum of the patient is blended with the thrombin of which a large portion of the thrombin has been disposed of (Behrens, AMIC)

Step 5: Extension and Flexion of the knee Blood and fibrin stick have extended the framework

Postoperative Rx result

Rehabilitation No movement of the knee for 7-10 days took after by Kinetec Crutch strolling for 10 weeks until osteotomy is recuperated and the deformity is filled

Why AMIC? Single stage methodology Coasts are direct Chondro-Gide ® gives a lattice to shape fibrocartilage it ensures and balances out the blood coagulation it averts seeping into the joint No contributor site bleakness No cell culture

But... We generally check the mechanical alignement with full leg radiographs or a CT for femoropatellar issues We are extremely liberal to play out an extra osteotomy

Results

J. Orthop. Res. 2000;18:781 HEALING OF CANINE ARTICULAR CARTILAGE DEFECTS TREATED WITH MICROFRACTURE, A TYPE II COLLAGEN MATRIX, OR CULTURED AUTOLOGOUS CHONDROCYTES H.A. Breinan, Hu-Ping Hsu, Scott Martin, and Myron Spector

Type II collagen-GAG platform Geistlich Biomaterials Trochlear Groove HA Breinan, et al . J . Orthop. Res. 2000;18:781

Hyaline Fibrocart. Stringy Total fill 100 80 75 60 50 40 25 20 0 µfx/II µfx/II 15 Wks Post-operation., n=8, Mean ± SEM % HA Breinan, et al . JOR 2000;18:781

Microfracture-Treated Defects, 15 weeks post-operation Adjacent articular ligament Defect Microfracture alone Defect Adjacent articular ligament Microfracture in addition to a sort II collagen embed HA Breinan, et al . JOR 2000;18:781

Total 42 instances of AMIC methodology (2003-2006)

Indications Femoropatellar joint 21 Femoral sore 6 Femoral OCD sore 9 Talar OCD injury 6 Total 42

Histology

Failures Femoropatellar joint 21 -> 0 Femoral sore 6 -> 1 Femoral OCD sore 9 -> 2 Talar OCD sore 6 -> 0 Total 42 -> 3

Failures 1 Femoral sore III° not debrided to an IV° sore 2 OCD sores without adequate debridement All different cases have a sactisfactory result (6-30 month development)

Case 2 44y old female Obesity 120kg Femoropatellar torment VAS (0-10) 9 Walking time 15 min

Patella Trochlea

Debridement

Drilling

Abrasion

Covering Patella with Chondro-Gide ®

Additional surgery Coverage of trochlea with Periost Cambium down Slight medialisation and ventralisation of tuberosity Lateral discharge

Result 1 year 2 year Preoperative VAS (0-10) 2-3 Walking 2 hours conceivable

Case 3: OCD Cangoroo strategy 44 year old male Large Osteochondral Defect on average femoral condyle

First step: Unloading Osteotomy

after 4 weeks Abrasion and microfracturing

Preparation of Chondro-Gide Matrix

Spongiosa + Hydroxyappatite + Serum + Fibringlue

Filling of the deformity and film suture

after 2 month

Conlusion In rundown this new technique for moment scope is intriguing on the grounds that it is promptly accessible and monetary. Whether it will offer adequate a ligament recover we should see. In any case, for OCD, which is primarily an issue of the bone, it offers a legitimate option. At times we can make a better than average fibrocartilage with hyaline like segments.

As likely all techniques, it doesn't endure mechanical over-burden due to an unfavorable mechanical hub arrangement. We subsequently are exceptionally liberal with arrangement remedy. A radical debridement is constantly fundamental

Thank you Hôpital cantonal Fribourg