J Knee Surg 2012; 25(01): 023-030
DOI: 10.1055/s-0031-1299652
Special Focus Section
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Particulated Articular Cartilage: CAIS and DeNovo NT

Jack Farr
1   Cartilage Restoration Center of Indiana, Greenwood, Indiana
,
Brian J. Cole
2   Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois
,
Seth Sherman
2   Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois
,
Vasili Karas
2   Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois
› Author Affiliations
Further Information

Publication History

05 August 2011

28 October 2011

Publication Date:
12 April 2012 (online)

Abstract

Cartilage Autograft Implantation System (CAIS; DePuy/Mitek, Raynham, MA) and DeNovo Natural Tissue (NT; ISTO, St. Louis, MO) are novel treatment options for focal articular cartilage defects in the knee. These methods involve the implantation of particulated articular cartilage from either autograft or juvenile allograft donor, respectively. In the laboratory and in animal models, both CAIS and DeNovo NT have demonstrated the ability of the transplanted cartilage cells to “escape” from the extracellular matrix, migrate, multiply, and form a new hyaline-like cartilage tissue matrix that integrates with the surrounding host tissue. In clinical practice, the technique for both CAIS and DeNovo NT is straightforward, requiring only a single surgery to affect cartilage repair. Clinical experience is limited, with short-term studies demonstrating both procedures to be safe, feasible, and effective, with improvements in subjective patient scores, and with magnetic resonance imaging evidence of good defect fill. While these treatment options appear promising, prospective randomized controlled studies are necessary to refine the indications and contraindications for both CAIS and DeNovo NT.

 
  • References

  • 1 Chondral Defect Repair with Particulated Juvenile Cartilage Allograft. Updated 2010; available at: http://www.zimmer.com/web/enUS/pdf/DeNovo_Chondral_Defect_Repair_White_Paper_05_2010.pdf
  • 2 Farr J, Yao JQ. Chondral defect repair with particulated juvenile cartilage allograft. Cartilage 2011; 2 (4) 346-353
  • 3 Cole BJ, Farr J, Winalski CS , et al. Outcomes after a single-stage procedure for cell-based cartilage repair: a prospective clinical safety trial with 2-year follow-up. Am J Sports Med 2011; 39 (6) 1170-1179
  • 4 Hjelle K, Solheim E, Strand T, Muri R, Brittberg M. Articular cartilage defects in 1,000 knee arthroscopies. Arthroscopy 2002; 18 (7) 730-734
  • 5 Maletius W, Messner K. The effect of partial meniscectomy on the long-term prognosis of knees with localized, severe chondral damage. A twelve- to fifteen-year followup. Am J Sports Med 1996; 24 (3) 258-262
  • 6 Saris DBF, Vanlauwe J, Victor J , et al; TIG/ACT/01/2000&EXT Study Group. Treatment of symptomatic cartilage defects of the knee: characterized chondrocyte implantation results in better clinical outcome at 36 months in a randomized trial compared to microfracture. Am J Sports Med 2009; 37 (Suppl. 01) 10S-19S
  • 7 Brittberg M, Lindahl A, Nilsson A, Ohlsson C, Isaksson O, Peterson L. Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. N Engl J Med 1994; 331 (14) 889-895
  • 8 Zaslav K, Cole B, Brewster R , et al; STAR Study Principal Investigators. A prospective study of autologous chondrocyte implantation in patients with failed prior treatment for articular cartilage defect of the knee: results of the Study of the Treatment of Articular Repair (STAR) clinical trial. Am J Sports Med 2009; 37 (1) 42-55
  • 9 Gross AE, Shasha N, Aubin P. Long-term followup of the use of fresh osteochondral allografts for posttraumatic knee defects. Clin Orthop Relat Res 2005; (435) 79-87
  • 10 Hangody L, Kish G, Kárpáti Z, Szerb I, Udvarhelyi I. Arthroscopic autogenous osteochondral mosaicplasty for the treatment of femoral condylar articular defects. A preliminary report. Knee Surg Sports Traumatol Arthrosc 1997; 5 (4) 262-267
  • 11 Moseley JB, O'Malley K, Petersen NJ , et al. A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med 2002; 347 (2) 81-88
  • 12 Steadman JR, Rodkey WG, Singleton SB, Briggs KK. Microfracture technique for full-thickness chondral defects: technique and clinical results. Oper Tech Orthop 1997; 7: 300-304
  • 13 Farr J. DeNovo NT natural graft tissue. Poster presented at: 8th World Congress of the International Cartilage Repair Society 2009; Miami, FL
  • 14 Asik M, Ciftci F, Sen C, Erdil M, Atalar A. The microfracture technique for the treatment of full-thickness articular cartilage lesions of the knee: midterm results. Arthroscopy 2008; 24 (11) 1214-1220
  • 15 Cole BJ, Pascual-Garrido C, Grumet RC. Surgical management of articular cartilage defects in the knee. J Bone Joint Surg Am 2009; 91 (7) 1778-1790
  • 16 Saris DBF, Vanlauwe J, Victor J , et al. Characterized chondrocyte implantation results in better structural repair when treating symptomatic cartilage defects of the knee in a randomized controlled trial versus microfracture. Am J Sports Med 2008; 36 (2) 235-246
  • 17 Knutsen G, Drogset JO, Engebretsen L , et al. A randomized trial comparing autologous chondrocyte implantation with microfracture. Findings at five years. J Bone Joint Surg Am 2007; 89 (10) 2105-2112
  • 18 Knutsen G, Engebretsen L, Ludvigsen TC , et al. Autologous chondrocyte implantation compared with microfracture in the knee. A randomized trial. J Bone Joint Surg Am 2004; 86-A (3) 455-464
  • 19 Albrecht F, Roessner A, Zimmermann E. Closure of osteochondral lesions using chondral fragments and fibrin adhesive. Arch Orthop Trauma Surg 1983; 101 (3) 213-217
  • 20 Frisbie DD, Lu Y, Kawcak CE, DiCarlo EF, Binette F, McIlwraith CW. In vivo evaluation of autologous cartilage fragment-loaded scaffolds implanted into equine articular defects and compared with autologous chondrocyte implantation. Am J Sports Med 2009; 37 (Suppl. 01) 71S-80S
  • 21 Lu Y, Dhanaraj S, Wang Z , et al. Minced cartilage without cell culture serves as an effective intraoperative cell source for cartilage repair. J Orthop Res 2006; 24 (6) 1261-1270
  • 22 Cheung HS, Cottrell WH, Stephenson K, Nimni ME. In vitro collagen biosynthesis in healing and normal rabbit articular cartilage. J Bone Joint Surg Am 1978; 60 (8) 1076-1081
  • 23 Adkisson IV HD, Martin JA, Amendola RL , et al. The potential of human allogeneic juvenile chondrocytes for restoration of articular cartilage. Am J Sports Med 2010; 38 (7) 1324-1333
  • 24 Stockwell RA. The interrelationship of cell density and cartilage thickness in mammalian articular cartilage. J Anat 1971; 109 (Pt 3) 411-421
  • 25 Namba RS, Meuli M, Sullivan KM, Le AX, Adzick NS. Spontaneous repair of superficial defects in articular cartilage in a fetal lamb model. J Bone Joint Surg Am 1998; 80 (1) 4-10
  • 26 Bonner KF, Daner W, Yao JQ. 2-year postoperative evaluation of a patient with a symptomatic full-thickness patellar cartilage defect repaired with particulated juvenile cartilage tissue. J Knee Surg 2010; 23 (2) 109-114
  • 27 Minas T, Gomoll AH, Rosenberger R, Royce RO, Bryant T. Increased failure rate of autologous chondrocyte implantation after previous treatment with marrow stimulation techniques. Am J Sports Med 2009; 37 (5) 902-908
  • 28 Gomoll AH, Probst C, Farr J, Cole BJ, Minas T. Use of a type I/III bilayer collagen membrane decreases reoperation rates for symptomatic hypertrophy after autologous chondrocyte implantation. Am J Sports Med 2009; 37 (Suppl. 01) 20S-23S
  • 29 Gibson T, Brian Davis W, Curran R. The long-term survival of cartilage homografts in man. Br J Plast Surg 1959; 11: 177-187
  • 30 Stone KR, Walgenbach AW, Freyer A, Turek TJ, Speer DP. Articular cartilage paste grafting to full-thickness articular cartilage knee joint lesions: a 2- to 12-year follow-up. Arthroscopy 2006; 22 (3) 291-299
  • 31 Crawford DC, Heveran CM, Cannon Jr WD, Foo LF, Potter HG. An autologous cartilage tissue implant NeoCart for treatment of grade III chondral injury to the distal femur: prospective clinical safety trial at 2 years. Am J Sports Med 2009; 37 (7) 1334-1343