Cells or No Cells, That is the Question

This week I performed a Denovo NT (live cells) and a Chondrofix (no cells) in two different patients. We went with the Chondrofix due to immediate weight bearing, i.e. crutches for only a few days, and this was the patient’s decision. My Chondrofix implants are looking just fine at 2 years now, but as readers of this blog will know the Denovo NT results are about 3 1/2 years out and I have a prejudice for live cells that grow over time. But I am open to various concepts, so this is by no means hard and fast…

Enter Arthrex, with a new product called BioCartilage. This is lyophilized (powdered) allograft from the Miami Tissue Bank, no cells.(http://www.arthrex.com/orthobiologics/biocartilage-micronized-cartilage-matrix)

As I understand it, the powder is used to supplement microfx and is glued in place with fibrin glue (also used for DenovoNT). the option of adding PRP to the implant is present, and I like that.

Now the cost of BioCartilage is low, and it may be done through the scope; both good things.  However, it is unclear that adding a powder to microfx plus a glue is any different from adding a glue alone. That is essentially what we did in the Chondux Study. (http://stm.sciencemag.org/content/5/167/167ra6)

It could be that most any jelly placed over microfx holes helps the bone marrow cells to have a higher residence time, hence improves the chances of “seeding”. IOW, the bone marrow stem cells don’t get wiped off as easily as the joint moves and is walked upon.

So the experiment to do…might be… microfx with fibrin glue..? Or perhaps a better glue with PRP?

Notice how the trinity of cells, scaffolds and growth factors begins to assert itself in various products.