Co-Founder of the New York Cartilage Repair Society Eric Strauss, MD, an orthopedic surgeon with New York City-based NYU Langone Health, discusses the society and biggest trends in cartilage repair today.
Question: What are the biggest trends in cartilage repair today? What are the most common treatments and up-and-coming treatments?
Dr. Eric Strauss: I think that we are in the middle of an exciting time when it comes to cartilage repair with so many advances being made with respect to both technology and surgical technique. Based on expanded experience and improved outcome data, the growing trend in cartilage repair is an individualized patient care approach where a number of different variables are factored into deciding which treatment method should be chosen in an effort to optimize long-term results.
We are paying close attention to the patient's lower extremity alignment, the status of their underlying subchondral bone, the condition of their menisci and the characteristics of their articular cartilage lesions as we choose from a growing list of cell-based and osteochondral treatment options. Additionally, there is a push to include biologics (platelet rich plasma, bone marrow aspirate and stem cells) into our treatment algorithms to improve the quality of the repair tissue that forms following cell-based treatment and incorporation of implanted osteochondral plugs.
The most common treatments being utilized include cell-based cartilage repair, primarily matrix-associated chondrocyte implantation and osteochondral autograft and allograft implantation. Treatment approaches on the horizon which are currently being investigated include scaffold-guided cartilage repair techniques utilizing both natural polymers, like calcium carbonate, chitosan, alginate and hyaluronan, and synthetic polymers like PLA and PLGA. Results from multiple ongoing studies looking at products like Agili-C, Novocart 3D and BST-Cargel will hopefully add additional treatment options for patients with symptomatic, full thickness articular cartilage lesions.
Q: What were the biggest revelations that came about during the meeting?
ES: One of the biggest takeaways from the inaugural meeting of the New York Cartilage Repair Society was that there is a great deal to gain from gathering cartilage surgeons together to review difficult cases and learn from each other as we strive to advance our field and provide the best possible care for the patients that we treat.
During the case discussion portion of the event, there was a great deal of healthy debate among the 35 cartilage surgeons in attendance, demonstrating different perspectives on clinical decision making, surgical technique and postoperative care. Through this discourse we came to realize that we all share the difficulties that go along with managing complex pathologies and a collegial educational forum like the New York Cartilage Repair Society is a great way to utilize each other's experiences and expertise to improve as cartilage surgeons.
Q: Where do you see the biggest opportunities for orthopedic providers to collaborate in cartilage repair treatment in the future?
ES: While the number of cartilage repair cases being performed in the United States is steadily increasing, the overall number of procedures remains relatively small. Collaboration between cartilage repair surgeons, most importantly, the sharing of outcome data is of paramount importance as we work to develop effective treatment algorithms. Additionally, creating a forum where difficult cartilage repair cases can be discussed among a network of experienced and trusted colleagues allows for the formulation of treatment plans that will improve the likelihood of a positive clinical outcome.