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Comparison of BioCartilage Versus Marrow Stimulating Procedure for Cartilage Defects of the Knee

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT02203071
Recruitment Status : Completed
First Posted : July 29, 2014
Results First Posted : March 16, 2020
Last Update Posted : March 16, 2020
Arthrex, Inc.
Information provided by (Responsible Party):
James Stannard, University of Missouri-Columbia

Brief Summary:

Subjects will be selected among the investigators' patient population who are already scheduled to receive a marrow stimulating procedure (MSP), with or without the addition of BioCartilage.

During the surgical operation for MSP, a portion of the patient's blood is taken out and used to form a patch to cover a cartilage defect of the knee. Currently it is considered standard of care to either form the patch using only a portion of the patient's blood, or form the patch using a portion of the patient's blood combined with an FDA-approved augmentation such as BioCartilage.

This study will collect outcomes data and MRI for patients that are undergoing MSP with and without BioCartilage augmentation, then compare the data between those who received BioCartilage and those who did not.

The primary endpoint is to determine whether subjects receiving a marrow stimulating procedure (MSP) augmented with BioCartilage have improved outcomes (measured using quality of life indicators, functional outcomes, and MRI) compared to subjects who receive MSP without the use of BioCartilage.

Condition or disease
Defect of Articular Cartilage

Detailed Description:

Recent developments in the treatment of articular cartilage defects have resulted in several techniques that involve the stimulation of native cellular components for the purpose of differentiation and proliferation in the cartilage defect. Techniques of interest for this study are the use of microfracture combined with platelet rich plasma (PRP), and a recently developed augmentation of the microfracture procedure-BioCartilage.

The microfracture procedure is performed with PowerPick. During the procedure, a patient with focal cartilage defect undergoes arthroscopic debridement of the defect before microfracture is used to create holes in the subchondral plate in order to provide access to mesenchymal stem cells (MSCs). To complete this marrow stimulating procedure (MSP), the microfractured region is filled with PRP harvested intraoperatively from the patient. A fibrin glue is then used to cover the defect and hold the PRP repair in place.

This basic MSP has been shown to regenerate cartilage tissue and improve joint function. Microfracture treatments using PRP are "shown to have good to excellent short-term outcomes in appropriately indicated patients" (Abrams, Mall, Fortier, Roller, & Cole, 2013), however successful long-term outcomes have not been demonstrated in the literature.

BioCartilage, a novel therapy developed by Arthrex Inc, is implemented as an augmentation of the basic approach of using microfracture and PRP. All aspects of the procedure, as well as indications for the procedure, are the same as the basic MSP described above, except the PRP is combined with BioCartilage powder, which acts as a scaffolding for cellular growth. BioCartilage is an FDA approved augmentation of microfracture treatment with PRP, and the powder itself contains no living cells.

Animal models using BioCartilage have provided data that supports the assertion that the BioCartilage augmentation may improve outcomes for patients who receive it; however there is currently no published human clinical outcomes data available for using BioCartilage (Abrams et al., 2013).

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Study Type : Observational
Actual Enrollment : 25 participants
Observational Model: Cohort
Time Perspective: Prospective
Official Title: Comparison of BioCartilage Versus Marrow Stimulating Procedure for Cartilage Defects of the Knee
Actual Study Start Date : June 2014
Actual Primary Completion Date : September 2018
Actual Study Completion Date : September 2018

MSP with BioCartilage
Patients receiving marrow stimulating procedure with BioCartilage adjunct.
MSP without BioCartilage
Patients receiving marrow stimulating procedure without BioCartilage.

Primary Outcome Measures :
  1. MRI Repair Tissue Comparison [ Time Frame: 1 year post-operatively ]
    The primary endpoint is to determine whether subjects receiving a marrow stimulating procedure (MSP) augmented with BioCartilage have improved outcomes (MRI) compared to subjects who receive MSP without the use of BioCartilage. Quantitative (%fill) and qualitative (tissue quality) MRI assessments of repair tissue will be performed by a musculoskeletal (MSK) radiologist who is blinded to treatment group, and compared for differences between treatment groups.

Secondary Outcome Measures :
  1. Short Form-12 Health Survey (SF-12) [ Time Frame: Approximately 2 years ]
    The 12-item Short Form Survey (SF-12) is a general health questionnaire. The SF-12 was constructed using questions drawn from each of the 8 dimensions of the MOS 36 item Short Form Survey (SF-36). It is designed to have similar performance to the SF-36, while taking less time to complete. Two summary scores are reported from the SF-12 - a mental component score (MCS-12) and a physical component score (PCS-12). Physical and Mental Health Composite Scores (PCS & MCS) are computed using the scores of twelve questions and range from 0 to 100, where a zero score indicates the lowest level of health measured by the scales and 100 indicates the highest level of health.

Other Outcome Measures:
  1. Marx Activity Rating Scale [ Time Frame: Approximately 2 years ]
    The Marx Scale consists of four questions concerning four activities or actions: running, cutting, deceleration, and pivoting. The patient or survey respondent is asked to report on the frequency with which they performed the activity in their healthiest state within the past year. The four knee functions are rated on a 5-point scale of frequency and scores are added up to a minimum score of 0 and a maximum of 16 points, with a higher score indicating more frequent participation.

  2. Knee Injury and Osteoarthritis Outcomes Score (KOOS) [ Time Frame: Approximately 2 years ]
    The Knee injury and Osteoarthritis Outcome Score (KOOS) assesses patient pain (9 items), other symptoms (7 items), function in daily living (17 items), function in sport and recreation (5 items), and knee related quality of life (4 items). Scores range from 0 to 100 with a score of 0 indicating the worst possible knee symptoms and 100 indicating no knee symptoms. The KOOS is a patient reported joint-specific score, which may be useful for assessing changes in knee pathology over time, with or without treatment.

  3. International Knee Documentation Committee (IKDC) Subjective Portion [ Time Frame: Approximately 2 years ]

    The IKDC Questionnaire is a subjective scale that provides patients with an overall function score. The questionnaire looks at 3 categories: symptoms, sports activity, and knee function. The symptoms subscale helps to evaluate things such as pain, stiffness, swelling and giving-way of the knee. Meanwhile, the sports activity subscale focuses on functions like going up and down the stairs, rising from a chair, squatting and jumping. The knee function subscale asks patients one simple question: how is their knee at present versus how was their knee prior to injury?

    Scores are obtained by summing the individual items, then transforming the crude total to a scaled number that ranges from 0 to 100. This final number is interpreted as a measure of function with higher scores representing higher levels of function.

  4. Number of Participants Who Were Able To Return To Return to Work or Sports Activity [ Time Frame: Approximately 2 years ]
    This is a two question survey administered to subjects that obtains subjective data "Yes / No" regarding whether the subject has been able to return to work or sports activity since surgery.

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population
Patients recruited from Missouri Orthopaedic Institute's patient population.

Inclusion Criteria:

I. Inclusion in the study will be considered when all of the following conditions are met:

  • The subject is a candidate for the use of a MSP with microfracture and PRP, with or without augmentation with BioCartilage, for treatment of a focal defect of the knee (trochlea or femoral condyle).
  • The subject is 18-years of age or greater
  • The subject is able and willing to consent to participate in the study
  • The subject is expected to be able to safely undergo MRI at the 1-year follow-up visit (no contraindications present, such as metal implants)
  • Infection or inflammatory arthropathy (such as rheumatoid arthritis) is absent in the operative knee

Exclusion Criteria:

II. Exclusion from the study will be determined by any one of the following conditions being met:

  • The subject is undergoing bilateral knee surgery
  • The subject is unwilling, or unable to consent due to psychiatric condition or legal incompetence
  • The subject is either pregnant, or a prisoner

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT02203071

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United States, Missouri
Missouri Orthopaedic Institute
Columbia, Missouri, United States, 65212
Sponsors and Collaborators
University of Missouri-Columbia
Arthrex, Inc.
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Principal Investigator: James P Stannard, MD University of Missouri-Columbia
  Study Documents (Full-Text)

Documents provided by James Stannard, University of Missouri-Columbia:
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Responsible Party: James Stannard, Principal Investigator, University of Missouri-Columbia Identifier: NCT02203071    
Other Study ID Numbers: 1211220
First Posted: July 29, 2014    Key Record Dates
Results First Posted: March 16, 2020
Last Update Posted: March 16, 2020
Last Verified: March 2020
Keywords provided by James Stannard, University of Missouri-Columbia:
Additional relevant MeSH terms:
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Cartilage Diseases
Musculoskeletal Diseases
Connective Tissue Diseases