Cartilage Fragment Implantation

Published on 11/03/2015 by admin

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Last modified 11/03/2015

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Chapter 11 Cartilage Fragment Implantation

Mats Brittberg

Introduction

The Cartilage Autograft Implantation System (CAIS) is a kit that utilizes morselized autologous hyaline cartilage harvested arthroscopically, affixed onto a synthetic, resorbable scaffold using a fibrin sealant and implanted in a single surgical procedure.

Similar to autologous chondrocyte implantation (ACI) techniques, CAIS results in chondrocyte-based tissue repair but does not require ex vivo isolation and culture expansion of the cartilage tissue biopsy. Rather, donor cartilage is morselized in situ into small fragments using a customized harvesting device. The resulting increase in surface area of the cartilage fragments promotes cell outgrowth and expansion of the chondrocytes incarcerated within the dense cartilaginous matrix. Fragments are then incorporated on a chondro-conductive scaffold and affixed in the lesion site using bioresorbable staples in a single-stage procedure.1,2

Technical Overview (Knee Joint)

The CAIS procedure requires the utilization of two single-use items (a CAIS harvester and a disperser) and two implantable devices (a CAIS scaffold implant and staples) (Fig. 11-1, A-H).

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FIGURE 11-1 A to H Devices used for the CAIS procedure include the harvester with collector, disperser, scaffold, staples, and staple instruments (mallet, punch, and inserter).

CAIS Harvester

The CAIS harvester is a single-use device with a battery-operated motor. The harvester tip, with the aid of surgical vacuum, directs the morselized cartilage mixed with irrigation fluids into a tissue collector.

CAIS Disperser

The CAIS disperser allows for even dispersion of the collected tissue onto the scaffold located in a bottom compartment of the disperser.

CAIS Scaffold

The CAIS scaffold is a 10 cm2 resorbable copolymer foam of polycaprolactone (PCL) and polyglycolic acid (PGA) that is reinforced with a polydioxanone (PDS) mesh. The scaffold is fixated within the prepared lesion site using CAIS staples (a resorbable PDS U-shaped strap).

Surgical Technique

Standard arthroscopic portals are used to assess the joint and the lesions. Cartilage is to be harvested for the fragmentation preparation.

Harvest and Collection of Cartilage Fragments

Cartilage can be harvested arthroscopically from healthy, low-weight-bearing areas (the lateral femoral trochlea, medial femoral trochlea, sulcus terminalis, or intercondylar notch). A minimum of 200 mg of tissue is required.

The CAIS disperser is prepared by placing the CAIS scaffold into the bottom of the disperser with the clear side of the cartridge ring facing up and the blue side facing down. The top tube is then assembled to the disperser base using alignment arrows and rotating clockwise to a hard stop. The disperser spring is then compressed by depressing the disperser cap until an audible click is heard (Fig. 11-2, A-E).

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