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Medical Professionals > Surgery > Biopsy

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Biopsy

An articular cartilage injury may be found during any arthroscopic knee procedure. Many patients who have other knee injuries, such as ACL injuries, have concomitant articular cartilage injuries. Prior to any arthroscopic procedure, it may be beneficial to educate the patient on all cartilage repair options and tell him or her that you may take a biopsy during the procedure.

Known Lesions

In many cases, you may already know that the patient has an articular cartilage lesion. It may have been confirmed during a previous arthroscopic procedure, prior to the decision to take a biopsy to initiate the production of CARTICEL^®. In this case, the patient is usually symptomatic and has had no improvement from a previous repair procedure.

At this point, you would typically discuss treatment options with the patient based on the treatment algorithm and their prior history.¹ If the patient is a clinically appropriate candidate for CARTICEL, he or she may benefit from Genzyme Biosurgery’s patient education materials and may find the patient section of this website a helpful resource.

When appropriate, obtain insurance authorization for the biopsy and the implant before the biopsy is taken. Visit our Reimbursement Information section to learn more or to contact a Carticel Care® Coordinator for assistance.

Suspected Lesions

Based on a patient’s medical history, you may suspect a lesion, or you may find a lesion during arthroscopic treatment of another knee injury.

It is generally helpful to educate the patient prior to the arthroscopy on all cartilage repair options that may be applicable to the various types of defects that are typically found during the procedure.

If arthroscopic assessment reveals a lesion, assess the best treatment option based on the cartilage repair treatment algorithm¹ and your pre-op discussion with the patient.

If the patient has failed a prior procedure for a symptomatic cartilage injury, and you think the patient may be a candidate for treatment with CARTICEL, we recommend you take a biopsy during the arthroscopy.

If you decide to repair the defect with an alternative procedure during the arthroscopy, we recommend that you do not take a biopsy. If the patient becomes symptomatic again at a later time, a biopsy can be taken at that point.

References

1. Cole BJ, Farr J. Putting it all together. Operative Techniques in Orthopedics. 2001;11(2):151-154.

CARTICEL is for autologous use and is indicated for the repair of symptomatic, cartilage defects of the femoral condyle (medial, lateral or trochlea), caused by acute or repetitive trauma, in patients who have had an inadequate response to a prior arthroscopic or other surgical repair procedure (e.g., debridement, microfracture, drilling/abrasion arthroplasty, or osteochondral allograft/autograft). CARTICEL should only be used in conjunction with debridement, placement of a periosteal flap and rehabilitation. The independent contributions of the autologous cultured chondrocytes and other components of the therapy to outcome are unknown. It is not indicated for the treatment of cartilage damage associated with generalized osteoarthritis. It is not recommended for patients whose knee meniscus has been surgically removed unless the patient has undergone surgical reconstruction prior to or concurrent with CARTICEL implantation.

Pre-existing conditions including meniscal tears, joint instability or malalignment of the joint should be corrected prior to or concurrent with CARTICEL implantation. It should not be used in patients with a known history of hypersensitivity to gentamicin, other aminoglycosides or materials of bovine origin. CARTICEL is not routinely tested for transmissible infectious diseases and may transmit disease to the healthcare provider handling CARTICEL. In addition, it should not be used in patients who have previously had cancer in the bones, cartilage, fat or muscle of the treated limb. Use in children, patients over age 65, or in joints other than the knee has not yet been assessed.

The occurrence of subsequent surgical procedures (SSPs), primarily arthroscopy, following CARTICEL implantation is common. In the Study of the Treatment of Articular Repair (STAR), forty-nine percent (49%) of patients underwent an SSP on the treated knee, irrespective of their relationship to CARTICEL, during the 4-year follow up. The most common serious adverse events (³ 5% of patients), derived from STAR, include arthrofibrosis/joint adhesions, graft overgrowth, chondromalacia or chondrosis, cartilage injury, graft complication, meniscal lesion, graft delamination, and osteoarthritis.

For more information on CARTICEL, please see the Package Insert (PDF).