CREATED BY EXPERIENCE

Instruments dedicated for precise cartilage debridement

Clinical problem - Articular cartilage defect

Source of cartilage defects

A number of different source of impairments can result in articular cartilage damage¹.

Those include:

genetic
vascular,
metabolic,
mechanical,
traumatic injuries

Cartilage defects can be of traumatic or degenerative in nature. Importantly, cartilage defects with traumatic origin are most suitable to be treated in order to induce reconstruction patient’s own cartilage².

Effect of untreated cartilage defect

Articular cartilage injuries have potential to progress to bigger lesions^³ and finally, if left untreated, lead to development of degenerative joint disease-osteoarthritis(OA)⁴

OA is a the leading musculoskeletal cause of disability in patients worldwide, characterized by pain, further loss of articular cartilage and degenerative changes in other joint structures, finally leading to joint failure⁵. OA leads to significant reduction of patient’s quality of life since it is one of the most frequent causes of pain and loss of mobility in adults⁶. What’s important, no functional cure of the disease is available, so the prevention of OA development is the only solution.

Optimal solution- biological reconstruction

Articular cartilage lesions generally do not heal, or heal only partially under certain biological conditions. Because of that, in past years a several different biological approaches that have been proposed in order to induce a significant and durable cartilage repair response⁷. The goal is to stimulate patient’s own regenerative potential so it can restore cartilage tissue structure and thus gain back function of the joint. Many approaches have been proposed and used; starting with simple bone marrow stimulation and finishing with complex chondrocyte transplantation⁸. Nevertheless, currently the most comprehensively clinically testes solution is Autologous Matrix-Induced Chondrogenesis (AMIC®) using collagen membrane Chondro-Gide®⁹.

Importantly, before any biologically-based tissue reconstruction is introduced cartilage defect has to be properly debrided.

Action - Ideal cartilage defect debridement

Why perfect cartilage debridement is so important?

The aim of perfect chondrectomy, so surgical removal of damaged cartilage is:

creation of even and stable cartilaginous edges, perpendicular to the joint surface
creation of suitably prepared bottom of the defect

Fulfilling those conditions is the key for optimum integration of the future cartilaginous regenerate.

Independent scientific data show that the preparation of the cartilage defect with precision can increase the potential of clinical success of biologically-based cartilage regeneration like those done with simple microfracturing or AMIC¹⁰.

Cartilage debridement with contrasting quality.
A- ideal cartilage defect debridement à defect with perpendicular defect walls + unviolated subchondral bone.
B- cartilage defect debridement with highly compromised quality a defect with inferior perpendicularity
+ violated subchondral bone.
Illustration adopted from: Puszkarz M. Chondrectomy – Review of Surgical Instrumentation and its Effectiveness¹⁰

Importance of defect perpendicular walls

Perfect cartilage defect debridement initially involves creation of cartilage perpendicular walls. When preparing the defect in anticipation of biologically-based cartilage repair, the surrounding cartilage walls should be sharply debrided in order to create walls that are perpendicular to the subchondral bone¹¹.

Cartilage debridement with contrasting quality.
A- ideal cartilage defect debridement à defect with perpendicular defect walls + unviolated subchondral bone.
B- cartilage defect debridement with highly compromised quality a defect with inferior perpendicularity
+ violated subchondral bone.
Illustration adopted from: Puszkarz M. Chondrectomy – Review of Surgical Instrumentation and its Effectiveness¹⁰

Importance of calcified cartilage removal without damaging of subchondral bone

Analysis show that removal of the calcified cartilage layer within chondral defects, while maintaining the integrity of the subchondral end-plate, is crucial because it will result in cartilage repair with better tissue quality¹².

Nevertheless, the base of the cartilage lesion has to be prepared with caution in order to minimize the violation of the subchondral bone. That’s because, the injury to subchondral bone architecture may lead to advancement of the subchondral plate and promote intralesional osteophyte formation, potentially having a great impact on the long-term outcomes of cartilage repair procedures¹³.

Cartilage debridement with contrasting quality.
A- ideal cartilage defect debridement à defect with perpendicular defect walls + unviolated subchondral bone.
B- cartilage defect debridement with highly compromised quality a defect with inferior perpendicularity
+ violated subchondral bone.
Illustration adopted from: Puszkarz M. Chondrectomy – Review of Surgical Instrumentation and its Effectiveness¹⁰

References:
1.Schwarz M. Articular cartilage biology.
2.Filardo G. Clinical Profiling in Cartilage Regeneration: Prognostic Factors for Midterm Results of Matrix-Assisted Autologous Chondrocyte Transplantation.
3.Rudd R. The effects of beveling the margins of articular cartilage defects in immature dogs.
4.Wluka A. The Clinical Correlates of Articular Cartilage Defects in Symptomatic Knee Osteoarthritis: A Prospective Study.
5.Murray C. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study.
6.Felson D. Osteoarthritis of the Knee.
7.Hunziker E. An Educational Review of Cartilage Repair: Precepts & Practice–Myths & Misconceptions–Progress & Prospects.
8.Karuppal R. Current concepts in the articular cartilage repair and regeneration
9.Steinwachs M. Systematic Review and Meta-Analysis of the Clinical Evidence on the Use of Autologous Matrix-Induced Chondrogenesis in the Knee.
10.Puszkarz M. Chondrectomy – Review of Surgical Instrumentation and its Effectiveness.
11.Blasiak A. Morphologic Properties of Cartilage Lesions in the Knee Arthroscopically Prepared by the Standard Curette Technique Are Inferior to Lesions Prepared by Specialized Chondrectomy Instruments.
12.Frisbie D. Effects of calcified cartilage on healing of chondral defects treated with microfracture in horses
13.Orth P. Alterations of the subchondral bone in osteochondral repair—translational data and clinical evidence.

Solution

Tools for IDEAL cartilage defect debridement need to:

Have sharp and durable edges able to create perpendicular walls without damaging surrounding tissue
Sharp and durable edges able to remove calcified cartilage without violation of the subchondral bone
Give access from each anatomical approach without additional effort
Allow cartilage defect debridement with minimal time but with high precision

We invite you to watch the treatment:

WATCH VIDEO: Chondrectoms in use during surgical procedure

Chondrectom™

Chondrectoms were designed to allow an easy separation of damaged and calcified cartilage layer from subchondral surface, leaving at the same time the intact subchondral plate.

Chondrectoms unique shape as well as special setup of theirs cutting edge allow precise shaping of the cartilage lesions, and formation of perpendicular walls of the defect. Tools can be used in every anatomical situation (every direction of approach) and in either open or arthroscopically approach.

Chondrectom™

Right Chondrectom

Left Chondrectom

Front Chondrectom

Parellel Chondrectom

Anterior femoral condyle cartilage defect debridement

Posterior femoral condyle cartilage defect debridement

Patellar cartilage defect debridement

Chondrectom™ Accessories for dry arthroscopy

Retracting plate

Designed for retracting of the joint capsule along with soft tissues, in order to provide sufficient working space within the joint cavity during dry arthroscopy.

Bioimplant inserter plate

Allows the introduction of any bioimplant into the joint cavity through an arthroscopic portal, sliding it along a halfpipe guide.

Halfpipe guide

Used to help in the introduction of the bioimplant into the joint cavity, through the integumentary system.

Curved raspatory

The curved raspatory is used to compress the matrix or bone pulp in place of the defect and finally shape its surface.

Arthoscropic shark hook

Tool with a pointed tip enables manipulation of the bioimplant within the joint.

Bone pulp guide with loader

Guide (inserter) od the bone pulp is designed to help in the implantation of the bone pulp into the bone cyst or bone defects. Tool allows also for compaction of the bone pulp during the implantation.