There is an axiom in surgery that you should never be either the first or the last to try a new technique. I have failed to take that advice on a number of occasions, most recently in January of 2011 when I began using Chondrofix implants to repair articular cartilage defects. These are allograft plugs that are sterilized- hence the cells are killed- and are fashioned into plugs, or dowels, of various sizes. They need to be inserted perpendicular to the joint surface, so they fit flush. Because the cartilage has good biomechanical characteristics- it is already hard, does not need to “grow”- I am allowing almost immediate weight bearing on these implants.
When a surgeon trials something new it is always good to pick cases carefully; the first group of Chondrofix patients have isolated cartilage problems, good looking radiographs, and are all super well motivated athletic types. One of the repairs was on the trochlea and the other 5 on the femoral condyles. All of the patients chose this implant over other options and are well aware that this is a new implant without any kind of a track record in humans.
So far there have been no complications. There is always a learning curve with a new device and I have learned that a clear angle of attack is required, with nothing (like a meniscus) in the way. Chondrofix cannot be placed in out of the way areas.
Having said that, the implants fit quite well and the instruments are good. On this week’s case, the incision was 1 5/8 inches long; I am definitely more comfortable implanting Chondrofix through a small incision.
Post op pain has been nominal. There have been no infections or known implant problems. Early on- and the longest followup is now about 6 months- pain relief has been excellent.
I have now been repairing cartilage for 14 years using a variety of methods. It is a pleasure to have available an off the shelf product with good implant characteristics, a simple technique, and a relatively easy post op course for the patient. It is too soon to make any comments about durability or to have an academic discussion about cell based vs. non cell based repair methods; but in this way the field is pushed forward. Progess.