Recent developments in cartilage repair have focused upon the use of allograft material combined with growth factors and the patient’s own stem cells- a composite material, if you like- that can be an inexpensive and substantially better product than microfracture alone. In spite of laudable success with products like Denovo NT, reimbursement issues on this and other products (in the 4- 8K range) remain daunting for most patients and providers, to the point where many needed surgeries just do not get done. As the projected U.S need for cartilage repair is well over 100,000 patients per year, we have to be realistic about this (and all other medical devices) in addressing options for the future.
As reported here earlier, I started using BioC early in 2013. This is an acellular matrix that is glued into position with the addition of growth factors (PRP), and combined with marrow stimulation. It can be performed either through a keyhole incision or through the scope, depending upon the location of the problem. Importantly, the implant kit can be kept on the shelf and is returnable if not used. The overall cost is around 1K. This number is within the parameters of most all facilities; translation: the surgicenter can allow the case to be performed, pay for the implant, and still make money.
In view of our national dialogue about economics the latter point should be understood by all.
Here is a link to the technique: http://www.arthrex.com/resources/video/Kg9hsjoIQkqS8wE7U0lJKA/biocartilage-preparation
Although it is early, I am pleased to report that at about six months the first group of BioC patients look quite good in terms of pain relief. Check this site in a couple of months for early MRIs. There have been no complications thusfar. One of the major issues with all kinds of cartilage repair is duration of followup; it will still be some years before I am able to make statements with confidence about longer term outcomes.