1. CARTICEL® Case Studies
Bennett Orthopedics & Sportsmedicine
Regenerating the Youth in You!
William F Bennett MD
Orthopedic Surgeon
CARTICEL® Case Studies

2. Case Study Template Patient Description
Age
Gender
Date of knee injury
Symptoms
Previous surgery (s)
List of co-morbidities (if any)
Joint stability
Alignment
Meniscal pathology
Employment & activities of relevance
Patient expectations (what do they want to return to?)
List all patient specifics that are relevant to the case and condition, i.e. patient expectations, return to specific function / employment, previous cartilage repair surgeries, previous injuries / medical history and co-morbidities.

3. Case Study Template Clinical Results
Improvement in Symptoms
Level of Activity
Activities of daily living
Return to sports and recreation
Limitations
Second Look Images (if any)
List all patient specifics that are relevant to the case and condition, i.e. patient expectations, return to specific function / employment, previous cartilage repair surgeries, previous injuries / medical history and co-morbidities.

4. CARTICEL Case Study #1 31 year-old male Air Force mechanic.
Recreational basketball player.
Acute basketball injury occurring in June 2004.
Patient presented patello-femoral instability of the left knee.
Patient desires to return to sports activities.
Case study and images courtesy of Jason M. Scopp, MD. Salisbury, MD.

5. CARTICEL Case Study #1: Clinical Findings
Pre-operative findings
X-ray revealed normal joint space and patella orientation.
Patient stated during the H & P that he “dislocated his knee cap” while playing basketball.
Arthroscopic Evaluation
2.0 cm X 2.0 cm (4.0 cm2) trochlear defect on the left knee treated with chondroplasty, which subsequently failed.
Confirmed lateral subluxation of patella.
Biopsy taken for CARTICEL implantation.
Case study and images courtesy of Jason M. Scopp, MD. Salisbury, MD.

6. CARTICEL Case Study #1: Implantation
CARTICEL implantation occurred after patient failed to respond to initial chondroplasty.
Following tibial tubercle osteotomy (Fulkerson) cut to correct lateral subluxation, the patella was reflected, exposing the trochlea defect.
CARTICEL was implanted and periosteal patch was sewn into place.
Case study and images courtesy of Jason M. Scopp, MD. Salisbury, MD.

7. CARTICEL Case Study #1: Clinical Results
Second-Look Arthroscopy
Underwent a second look arthroscopy 9 months after implantation when patient re-injured knee (patient’s son bumped into the knee).
Integrated, restored cartilage congruent with joint surface of the trochlea.
Clinical Outcome
Patient completed rehabilitation program, returned to work and recreational sports, and continues to play basketball regularly.
Patient does not have any limitation with regards to desired level of activity.
All patient must undergo a physician-prescribed rehabilitation program that last approximately months.
Case study and images courtesy of Jason M. Scopp, MD. Salisbury, MD.

8. CARTICEL Case Study #2: 35 year-old male assembly line worker
Recreational basketball player and high school football coach
Sustained injury while playing basketball in April of 2005
Patient presented with pain, edema and instability in the right knee.
Patient desires to return to sports activities.
Case study and images courtesy of Akbar Nawab, MD. Louisville, KY.

9. CARTICEL Case Study #2: Clinical Findings
Co-Morbidities
Pre-operative MRI revealed a complete ACL tear, medial and lateral meniscus tears, all which were repaired at the time of initial arthroscopy.
No malalignment.
Anterior Crucitate Ligament (ACI)
Medial Femoral Condyle (MFC)
Case study and images courtesy of Akbar Nawab, MD. Louisville, KY.

10. CARTICEL Case Study #2: Clinical Findings
Initial arthroscopy
Large 8.75 cm2 (2.5 cm X 3.5 cm) MFC lesion with detached cartilage segment.
Lesion was treated with debridement, which subsequently failed.
Detached articular cartilage segment in interchondylar notch was removed.
Biopsy taken for CARTICEL implantation.
ACL was reconstructed and menisci were repaired at this time.
Case study and images courtesy of Akbar Nawab, MD. Louisville, KY.

11. CARTICEL Case Study #2: Implantation
CARTICEL Implantation occurred after patient failed to respond to initial debridement.
MFC defect after debridement.
Periosteal harvest from tibia.
MFC defect post-implantation.
Case study and images courtesy of Akbar Nawab, MD. Louisville, KY.

12. CARTICEL Case Study #2: Clinical Results
Second-Look Arthroscopy
Arthroscopic evaluation 22 months post CARTICEL implantation.
Loose meniscal suture anchor was removed.
Meniscus tear healed and ACL was stable.
Integrated, restored cartilage congruent with joint surface of the MFC.
Clinical Outcome
Patient completed rehabilitation program and resumed work as assembly line laborer.
Full return to playing basketball and coaching football.
No complaints of instability.
No pain after loose anchor removal.
Integrated MFC with no hypertrophy or delamination
All patient must undergo a physician-prescribed rehabilitation program that last approximately months.
Case study and images courtesy of Akbar Nawab, MD
Case study and images courtesy of Akbar Nawab, MD. Louisville, KY.

13. Important Treatment Considerations
CARTICEL is for autologous use and is indicated for the repair of symptomatic cartilage defects of the femoral condyle (medial, lateral or trochlea), caused by acute or repetitive trauma, in patients who have had an inadequate response to a prior arthroscopic or other surgical repair procedure (e.g., debridement, microfracture, drilling/abrasion arthroplasty, or osteochondral allograft/autograft). CARTICEL should only be used in conjunction with debridement, placement of a periosteal flap and rehabilitation. The independent contributions of the autologous cultured chondrocytes and other components of the therapy to outcome are unknown. It is not indicated for the treatment of cartilage damage associated with generalized osteoarthritis. It is not recommended for patients whose knee meniscus has been surgically removed unless the patient has undergone surgical reconstruction prior to or concurrent with CARTICEL implantation.
Pre-existing conditions including meniscal tears, joint instability or malalignment of the joint should be corrected prior to or concurrent with CARTICEL implantation. It should not be used in patients with a known history of hypersensitivity to gentamicin, other aminoglycosides or materials of bovine origin. CARTICEL is not routinely tested for transmissible infectious diseases and may transmit disease to the healthcare provider handling CARTICEL. In addition, it should not be used in patients who have previously had cancer in the bones, cartilage, fat or muscle of the treated limb. Use in children, patients over age 65, or in joints other than the knee has not yet been assessed.
The occurrence of subsequent surgical procedures (SSPs), primarily arthroscopy, following CARTICEL implantation is common. In the Study of the Treatment of Articular Repair (STAR), forty-nine percent (49%) of patients underwent an SSP on the treated knee, irrespective of their relationship to CARTICEL, during the 4-year follow-up. The most common serious adverse events (≥5% of patients), derived from STAR, include arthrofibrosis/joint adhesions, graft overgrowth, chondromalacia or chondrosis, cartilage injury, graft complication, meniscal lesion, graft delamination, and osteoarthritis.