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Disclosures
- Consultant: Arthrex, Veterinary Recommended
Nutraceuticals, TissueGen
- Royalties: Arthrex
- Scientific Board: Kensey Nash
Revisiting microfracture Lisa A. Fortier, DVM, PhD, DACVS James Law - - PowerPoint PPT Presentation
Revisiting microfracture Lisa A. Fortier, DVM, PhD, DACVS James Law - - PowerPoint PPT Presentation
Cornell University College of Veterinary Medicine Revisiting microfracture Lisa A. Fortier, DVM, PhD, DACVS James Law Professor of Surgery laf4@cornell.edu Disclosures Consultant: Arthrex, Veterinary Recommended Nutraceuticals, TissueGen
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Available tools Economic and regulatory realities
- 2 stage – ACI (1995), MACI (2016)
- Single stage – Microfracture
- Put down your awl
– Microfracture plus
- BMAC, BioCartilage, DeNovo, Cartiform, etc.
- Mechanical mini abrasion arthroplasty
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Theory vs reality
Fortier JKS 2013
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Cartilage & bone affected!
Fortier, AJSM 2016
surface view saggital
2 months 13 months 6 months
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Burn no bridges
moderate echo time FSE A: subchondral bone B: cartilage C: fibrocartilage D: subchondral sclerosis Central osteophyte Fat supressed spoil gradient MRI Courtesy, T Mosher McIlwraith, Arthroscopy 2011 Courtesy, John Kennedy
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Put down your (conventional) awl!
AJSM 2009
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Awl of them
Gianakos Arthroscopy 2016 Small is better, but damage inevitable
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What really matters?
Prepare the defect walls Remove calcified cartilage mini abrasion arthroplasty to bleeding
Arthroscopic Cobb Elevator
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Available tools Future
- Small/slow drill, hollow awl?
- Microfracture plus
– BMAC, BioCartialge, DeNovo, Cartiform, etc.
- Mini mechanical abrasion arthroplasty
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Fortier JBJS 2010 Chu JBJS 2017 Min, Arthroscopy 2017
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