Description of Medical ServiceThe proposed medical service is insertion of a chitosan-based cartilage biomatrix implant, in conjunction with the marrow stimulation technique (microfracture) for repair of focal cartilage defects. Using an arthroscopic awl, multiple holes or microfractures are made in the defect 3-4 mm apart. The chitosan-based biomatrix device is mixed with autologous whole blood and is applied to the microfractured cartilage lesion, where it physically stabilises the clot, and guides and enhances marrow-derived repair to promote hyaline cartilage regeneration. Randomised controlled trial (RCT) evidence demonstrates superior lesion filling and superior repair tissue quality when the chitosan-based cartilage biomatrix implant is used in conjunction with microfracture, compared with microfracture alone in the repair of focal cartilage defects of the knee (Stanish et al 2013).
Description of Medical ConditionArticular cartilage provides a low-friction gliding service, acts as a shock absorber and minimises peak pressures on the subchondral bone in the joints (Bhosal 2008). Damage to the articular cartilage predominately follows acute traumatic injuries, however other causes of articular cartilage damage can include; prolonged periods of stress due to obesity or old age and long periods of inactivity (Cole 2009; Hjelle 2002). Typical symptoms of articular cartilage lesions include; swelling, local pain, locking and catching (Cole 2009). Articular cartilage lesions are relatively common, with an estimated prevalence of 60% found in patients undergoing knee arthroscopy (Aroen 2004; Curl 1997; Hjelle 2002) with lesions of the hip and ankle less common (Aurich 2014; Loken 2014).
Reason for ApplicationReferral from Prostheses List Advisory Committee (PLAC)
Medical Service TypeTherapeutic
Previous Application NumberNot applicable
Application FormApplication Form (Word 234 KB)
Application Form (PDF 887 KB)
Consultation SurveyConsultation survey (Word 70 KB)
Consultation survey (PDF 394 KB)
PICO ConfirmationPICO Confirmation (PDF 1663 KB)
PICO Confirmation (Word 3160 KB)
Public Summary DocumentPublic Summary Document (Word 212 KB)
Public Summary Document (PDF 694 KB)