1569 – Chitosan-based cartilage biomatrix implant (BST-CarGel), in conjunction with the marrow stimulation technique (microfracture), for repair of focal cartilage defects

Referral from Prostheses List Advisory Committee (PLAC).

The 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).

Type: Therapeutic

Articular 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).

• PASC meeting: 8 August 2019
• ESC meeting: 12 June 2020
• MSAC meeting: 28 to 29 July 2020