Next, we have Derek Jones from Ochsner down in New Orleans. He's going to talk to us about what's new in the pipeline for cartilage surgery. All right. Thank you. My disclosures are on the website. So, you know, Riley Williams showed way back that osteochondralografts are basically a slow decaying type graft when they're stored at 4 degrees Celsius. And the Missouri Osteochondral Preservation System uses room temperature storage and demonstrated in this K9 model that at 60 days, there was a significant difference in fluorescence staining as well as by close assessment in the graft at 60 days versus the standard preservation techniques. Viability was significantly different as well at 28 and 60 days, and that was maintained, you know, in several studies as well. They looked at these patients, 58 patients, and had a standard preservation in 12 of them. Forty-eight had additional, or 46, sorry, mops grafts, and showed a much higher survival rate of four years versus the standard preservation technique. They found that unipolar lesions did better than bipolar lesions, as you would expect. However, both were significantly better in the mops versus the standard preservation technique. This is a patient who had a previous microfracture, lateral release, which I think is the kiss of death for a knee, and we used a mops graft with limited bone implantation, and patient did pretty well with the repair of the release, and then MRI six months post-op. Another interesting case, a patella graft where I used a mops graft, a patella, but didn't have a femoral graft for the standard care graft, was used for the femoral side. You can see at post-op, one year, the difference in the incorporation of two grafts, so there may be something there in terms of incorporation. Screws were used in the patella in that case. Dr. Letterman just talked about Macy technique. Don't forget this is a very solid technique that's been studied very well. We had a long history, obviously, prior to using this procyon type one, type three collagen carrier. It is a carrier. Remember, it's not something that's permanent, but does last, and gets to that homogeneous population of cells in there. So, something to be used. The summit study by Daniel Sarris and colleagues was really a greatly run study. I mean, 72 patients in each category, limited withdrawal in each category, similar demographics, and demonstrated significant difference in post-op follow-up, two years using KUS subscale pain assessments, as well as a significant difference in terms of responder rate. KUS subscale analysis demonstrated that all categories were statistically significantly better in the Macy arm of the study versus microfracture. When they did a responder rate assessment, responder rates were much higher as well in the Macy arm. And as Dr. Letterman just talked about, four centimeter square lesions usually do better with Macy than a microfracture. And that was shown in this study as well. Responder rates were assessed out five years and demonstrated no significant diminishment in the microfracture arm of the study. However, the Macy arm of the study maintained a significantly better improvement out to five years. This is a new graph that we've been using, viable cartilage fibers. And we're mixing it with cartilage allograft matrix. This is once again for small lesions. We looked at these for cellular characterization assessment and had similar surface markers to normal chondrocytes. So it's really a chondrocytic phenotype was demonstrated by fluorescent staining, by safranin staining, by proteoglycan assessment, as well as a type two production by brown staining. Proliferation was maintained in cells that have been cryopreserved out to 24 months. This is a GOAT study. We assessed both arms, three in the microfracture arm, three in the viable cartilage fiber arm, and demonstrated once again that there was good proteoglycan production in the VCA arm versus the microfracture where you could expect a type one collagen versus type two in the VCA arm of the study. This is typically cryopreserved at room temperature. You thaw the cells out, the fibers out, and remove the media, decant it, rinse three times. And you want to do a gentle debridement not penetrating that subchondral bone plate. It should be used for focal defects. It can extend a little bit to the peripheries in this lesion, but you want good vertical boards to hold this graft in place. This is a small subset of 20 patients we looked at. And most were patella lesions, ICRS grade IV-A lesions, typically minimal bone involvement. And these are outcomes measures. The only one that was not statistically significant was MSF-12, however, all of the measures were significantly different and improved significantly at two years following the small subset of patients. This is a bar graph showing this as well. With a significant improvement, particularly in sports and quality of life assessments at two years. IKDs and lysome increased as well. So significant improvements in functional level. These were mostly younger patients with isolated defects with a combined possible MPFL, for example. So this is a patient with an MPFL and VCA, a Mississippi State student. We put the graft in place, and then at three months we see that the graft was maintained, and it did very well. A JILI-C is an implant. Some of the panelists were involved in this study. It's a carbonate-argonate-argonate implant, and it's just used to try to draw the cells into place. They looked at 14 fresh catabolic specimens and demonstrated that there was type 2 production and proteoglycan production in the cells present within that. When they looked at gene expression, type 2, agrican production was significantly improved based up, compared to control in the arm of the study. Thirteen patients were assessed and demonstrated significant improvements in those post-op outcomes measures. The same KUSAB scales I showed in the previous slides, and MOCART scores improved gradually as well. A level 4 study was done, and that more recent study has just been published, but demonstrates that in kelvin 2 and 3 type scores, this is arthritic patients, JILI-C was very effective and had significant fill of these defects. You can see the fill rate was approximately 80% at 24 months, which is pretty impressive. Thank you.

cartilage surgery advancements

MOPS

improved viability

Macy technique

VCA graft