SLR - November 2012 - N. Jake Summers
Reference: Farr J., Cole B.J., Sherman S., Karas V. Particulated Articular Cartilage: CAIS and DeNovo NT. Journal of Knee Surgery. 2012; 25:23-30.
Scientific Literature Review
Reviewed by: N. Jake Summers, DPM
Residency Program: Mount Auburn Hospital, Harvard Medical School, Cambridge, MA
Podiatric Relevance:
Osteochondral defects (OCDs) are a complicated and challenging presentation for many foot and ankle surgeons. Common locations for osteochondral defects in the foot and ankle are the talar dome and the first metatarsal head. New techniques for repairing osteochondral defects have been described in orthopaedic literature, and one such method being used for defects on the articular surface of the knee is the use of particulated articular cartilage allograft or minced cartilage autografts. Two systems currently being studied for use in the knee are the Cartilage Autograft Implantation System (CAIS) and the DeNovo Natural Tissue (NT). Application of these techniques to the foot and ankle should be continually evaluated and considered.
Methods:
The authors reviewed current literature for both the CAIS and DeNovo NT systems as well as discussed indications/contraindications and surgical techniques for using these two systems. One study compared the clinical outcomes of 29 randomized patients who underwent either MFX (microfracture) or CAIS repair of OCDs, analyzing the outcomes at three weeks, and six, 12, and 24 months. Several standardized outcome assessment tools and scoring systems were used including the International Knee Documentation Committee (IKDC) and the Knee Injury and Osteoarthritis Outcomes Score (KOOS). Another study to evaluate DeNovo NT was an interim report of 25 patients in an ongoing multicenter, prospective, single-arm study. The interim report used IKDC, KOOS and visual analog scale (VAS) scores. Four of the 25 patients have reached the 24-month follow-up period. A single case report is also presented at 24-month follow-up after DeNovo NT repair.
Results:
Of the 29 patients who underwent wither MFX or CAIS, the IKDC score of the CAIS group at both 12 and 24 months was significantly higher than the MFX group. There was no difference between the two groups when qualitative analysis of the imaging data was performed, except that the MFX group had a higher incidence of osteophyte formation. Of the four patients in the DeNovo NT group that had completed the follow-up period, all four patients showed improvements in the KOOS, IKDC, and VAS scores. The case report patient who underwent DeNovo NT repair had substantial clinical improvement in both pain and function with both the IKDC and KOOS outcome measures.
Conclusions:
Both the DeNovo NT and CAIS systems may be viable future treatments options for patients with symptomatic osteochondral defects. The outcomes were favorable for the patients in the studies that were reviewed by the authors, but the population size and incompleteness of the studies indicates that further study is needed and more trials need to be performed before specific recommendations can be made.