When deciding about what type of cartilage repair is the best match for a given patient, there are many factors to consider. I often get asked what is the “sweet spot”- the optimal use- for a given implant. That is about the same as asking what type of car is best to buy, and I am sure you’ll get lots of opinions on that.
Factors to consider include location of the cartilage lesion, size, shape, the quality of the underlying bone, the compliance of the patient, the presence of other abnormalities, and the economics involved. The latter is not confined just to the payor- most patients in my practice want to get back to work as rapidly as possible, and I totally sympathize with that. If you place some people on “disability”, that can mean a large shock to their income.
When I was performing ACI exclusively, many patients in fact opted not to have cartilage repair because they could not be on crutches for a prolonged period of time. Welcome to the real world!
The Chondrofix implant may offer a way forward. This is a hard implant, with cartilage that is already grown. it is biomechanically tested to be similar to adult ” normal” cartilage. Chondrofix resembles a dowel or a plug, and it is impacted into the bone. Walking upon the leg soon after surgery should not damage the implant.
The problem is right now, since Chondrofix is new, we have no more than 4-5 months experience with it. So my present advice is to gradually put some pressure upon the leg over a 10 day period, and then use a cane for a couple of weeks. This is much,much faster rehab than ACI or Denovo NT.
All potential patients need to understand that new implants always involve a learning experience, and you don’t get that from reading books. If we can bring cartilage repair to more people who need it by offering a quicker rehab, that would be a step forward that cannot be minimized.