What is Cartiform?
Cartiform is an allograft osteochondral graft implant harvested from human cadaveric specimens. It is employed in individuals with cartilage lesions or defects (injuries or damage) in the knee as part of a cartilage restoration treatment.
Articular or hyaline cartilage is the tissue that covers the bone surface of the knee which helps in smooth interaction between the two bones in the knee joint. It has less capacity to repair by itself because there is no direct blood supply to cartilage.
Cartiform is a cryopreserved cartilage graft implant comprising cartilage growth factors, viable cartilage cells, and proteins that assist in cartilage healing. The graft implant is porous with an intact bony scaffold, enabling flexibility. The pores enhance surface area and enable the preservation of cartilage cell viability throughout the graft. Growth factors are released and allow for the migration of cartilage cells into the graft after implantation into the cartilage lesion. The implant is designed to integrate with the surrounding tissue and help in treating chondral (of or relating to cartilage) defects. Cartiform functions by filling in a chondral lesion with viable cartilage cells and then releasing growth factors to increase the healing process.
Indications for Cartiform
Your physician may recommend Cartiform for the treatment of isolated, full-thickness cartilage defects of the knee with minimal subchondral bone loss (less than 5 mm). The subchondral bone is the bone located underneath joint cartilage. Cartiform can be a beneficial option for individuals preferring a single surgical procedure and is usually utilized for lesions of 1 to 2 square cm, and in primary or revision cases.
Preparation for Cartiform
Preoperative preparation for Cartiform placement will involve the following steps:
- You may need to undergo tests such as blood work and imaging to help detect any abnormalities that could compromise the safety of the procedure.
- You will be asked if you have allergies to medications, anesthesia, or latex.
- You should inform your doctor of any medications, vitamins, or supplements you are taking, or any conditions you have such as a blood disorder or a heart condition.
- You should refrain from medications or supplements such as blood thinners, aspirin, or anti-inflammatory medicines for 1 to 2 weeks prior to surgery.
- You should not consume any solids or liquids at least 8 hours prior to surgery.
- You should refrain from smoking and alcohol for a stipulated period both before and after surgery as they can negatively affect the healing process.
- You should arrange for someone to drive you home after surgery.
- A signed informed consent form will be obtained from you after the pros and cons of the surgery have been explained in detail.
Procedure for Cartiform Placement
The placement of the Cartiform implant is usually performed through a combination of arthroscopy and open surgery, under general or spinal anesthesia. An incision is made to expose the knee joint defect. The size of the defect is then measured, and a portion of the cartilage and underlying bone is removed. A cryopreserved osteochondral allograft (Cartiform) taken from a deceased donor is sterilized, prepared in the laboratory, and tested for risk of disease transmission. It is then trimmed with a special instrument to match the size of the prepared defect. Cartiform is then secured into the defect created in the recipient's bone using suture anchors. The incision is then closed, and a dressing is applied to the joint.
In general, Cartiform implantation involves the following steps:
- You will be positioned supine (face-up) on the operating table.
- The knee area is cleaned and sterilized using an antiseptic solution.
- A small incision is made on the knee for placement of an arthroscope - a small fiberoptic instrument with a tiny lens and video camera.
- The arthroscope is used to document and assess the size, location, and grade of cartilage defects within the knee and to make sure that the individual is a suitable candidate.
- A longitudinal incision of 6 to 8 cm is then made over the knee, depending on the defect location, to gain access to the interior of the joint.
- Your surgeon then performs debridement of the joint area (femoral, tibial, and/or patellar) to remove damaged cartilage and bone. Care is taken to prevent damage to healthy cartilage and bone tissue and the area of defect is prepared for Cartiform placement.
- Based on the size of the defect, the Cartiform graft is trimmed to perfectly ?t the lesion, and the perfectly sized Cartiform graft obtained from a cadaver specimen is then transplanted into the area of the defect. The graft is secured with suture anchors and covered with a thin layer of fibrin glue and allowed to integrate and promote healing.
- Finally, the incision is closed in layers and covered with a bandage and sterile dressings.
Postoperative Care and Recovery
In general, postoperative care instructions and recovery after humeral head reconstruction with osteochondral allograft transplantation involve the following steps:
- You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover. You may need to stay in the hospital for a couple of days before being discharged.
- You may notice pain, swelling, and discomfort in the operated area. Pain and anti-inflammatory medications are provided as needed to address these. Antibiotics are also prescribed to address the risk of surgery-related infection.
- You will be placed on assistive devices such as crutches, with instructions on restricted weight-bearing for a specified period of time. You are encouraged to walk with assistance as frequently as possible to prevent blood clots.
- Instructions on surgical site care and bathing will be provided to keep the wound clean and dry.
- Refrain from strenuous activities for the first few months and from lifting heavy weights for at least 6 months. A gradual increase in activities over a period of time is recommended.
- An individualized physical therapy regimen will be designed to help strengthen knee muscles and optimize knee function.
- Most patients are able to resume their normal activities in 3 to 4 weeks after surgery; however, returning to sports may take 6 months or longer.
- Refrain from driving until you are fully fit and receive your doctor’s consent.
- A periodic follow-up appointment will be scheduled to monitor your progress.
Risks and Complications
Cartiform implantation is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:
- Postoperative pain
- Joint stiffness
- Graft rejection
- Damage to nerves and vessels
- Damage to healthy cartilage or bone
- Thromboembolism or blood clots
- Adverse reactions to anesthesia/allergic reactions