A Primer in Cartilage Repair and Joint Preservation of the by Tom Minas MD MS

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By Tom Minas MD MS

A Primer in Cartilage fix and Joint renovation of the Knee provides the total variety of treatments for a altering, more and more more youthful sufferer inhabitants. Dr. Thomas Minas demonstrates every one technique-from non-surgical to mini-incision overall knee arthroplasty to the hot advancements in tissue biologics-through a step by step procedure. This hugely visible, multimedia reference courses you in deciding on the Read more...

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Procedures that may Figure 4–3 A small well-shouldered chondral defect on the left prevents damage to the opposing surface because the shoulders of the defect support the subchondral bone. However, the defect on the right excessively overloads the shoulders, leading to premature breakdown of the supporting surface with abrasive changes developing on the opposing tibial surface. Persistent symptoms and degenerative changes are likely in this situation. A repair tissue that stabilizes the small defect usually is adequate.

Several authors have conducted studies comparing different repair techniques, such as microfracture, mosaicplasty, and ACI, with conflicting results. These studies 42 PART 1 DECISION MAKING are often compromised by the nature of the procedures they were designed to investigate; for example, ACI as a cell-based therapy is dependent on a sophisticated cell culturing process. The cell culturing process requires phenotypic validation, cell viability assessment, and sterility process validation according to the FDA, GLP (Good Laboratory Practices), and GMP (Good Manufacturing Practices) to ensure sterile, safe, phenotypically stable cell implantation; however, not all authors use standardized and approved laboratory facilities.

We would also like to draw the reader’s attention to the fact that several well performed case series (level-IV evidence) score very well on the CMS. These studies largely take into consideration multiple aspects of good methodological quality such as independent investigator, sufficient number of patients, well-described rehabilitation protocol, validated outcome measures and so forth, and are mainly lacking in not having a control group. ” I agree with their recommendation that inclusion and exclusion criteria should be well established, that validated outcome measures for cartilage injuries should be used, and that outcome assessment should be performed by an independent investigator, ideally by the patient without assistance.

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