CaReS^®

Introduction

Small defects are hard to remember, easily forgotten, and years later they lead to arthrosis.

Many people suffer from inflamed, painful cartilage defects. With every step we take, 5.5 times our body weight presses on our knees. By this formula, a person weighing 60 kg puts 330 kg of pressure on the joints when walking. A wrong movement under this load can damage the cartilage. Although joint cartilage has some ability to repair itself, over time these small defects come to need surgery.

When these defects cause pain and inflammation, they lower the person’s quality of life. Studies have shown that in Germany alone 8–9 million people are affected. This is serious, because cartilage degeneration progresses. Later on the cartilage surface wears away completely, and bone rubbing on bone brings on a painful stage.

Treatment Options

Medication and physiotherapy help relieve the symptoms of cartilage damage but cannot provide a real cure, which leaves surgery as the only option. Although many new techniques have been developed for this purpose, their effects are limited. The CaReS® cartilage regeneration technology produced by Ars Arthro is the first and biggest step in this field, with a lasting and effective regenerative effect on cartilage defects.

Microfracture

Suitable only for very small defects. Small holes are made in the base of the joint surface defect so that mesenchymal stem cells from the bone marrow form tissue of a fibrocartilage character. This new tissue is mechanically softer and weaker than the hyaline cartilage of the joint, and it wears and degenerates over time.

Mosaicplasty

Osteochondral plugs taken from non-weight-bearing areas of the joint are placed in a mosaic pattern in the defect, aiming at regeneration there. Mostly hyaline cartilage develops. However, the defects left where the plugs were taken, and the fact that the method cannot be repeated if it fails, are important drawbacks. It is therefore useful not as a first choice but especially where microfracture has failed.

Autologous chondrocyte transplantation (ACT)

A cartilage biopsy taken arthroscopically from a non-weight-bearing part of the joint is multiplied in the laboratory with autologous or another suitable biological serum; in a second procedure the cells are placed in the defect and covered with a periosteal flap. Its drawbacks: the cells are transplanted in a liquid medium, and a periosteal flap is needed to hold them, which lengthens the incision and surgery time, the hospital stay, joint swelling and restricted movement, and so the recovery.

For Patients

CaReS® is a new discovery in autologous cell-based regenerative treatment that restores the patient’s function and mobility after cartilage damage.

For Physicians

Autologous chondrocyte transplantation has given a positive response in 60–90% of focal cartilage defects of the knee. But ACT has found limited use because the operation is difficult in time and technique, so a matrix was needed that could fix and transfer the cells flawlessly. Compared with other matrices made for this purpose (collagen foam, polymers, etc.), Ars Arthro technology is the only product that brings all the advantages together.

Studies

Classic ACT and CaReS® compared

Between October 2002 and April 2003, ACT and CaReS® were applied to 20 patients and the results of the two methods were compared. The results were presented at the International Cartilage Repair Society congress in Belgium.

Mobility and reproducibility

After 6–12 months, patients treated with CaReS® showed better joint function and mobility than those treated with ACT. The one- and two-year results of CaReS® showed high reproducibility.

Oedema and swelling

In ACT patients, oedema and swelling of the joint were seen even a year after surgery. In CaReS® patients, no significant oedema or swelling was seen from 3 months after surgery.

Operation time and trauma

Surgery with CaReS® took 50% less time than other methods. The average incision of 9 cm (37% shorter than other procedures) lowers the risk of infection and supports post-operative rehabilitation.

MRI and histology

Six months after surgery, the damaged areas of CaReS® patients were filled with regenerated tissue giving an isointense cartilage signal. Second-look arthroscopy showed smooth morphology, well integrated with the surface and the surrounding cartilage. Histology one year after surgery showed a homogeneous distribution of cartilage cells in the transplant area.

Rehabilitation

Rehabilitation after CaReS® follows one of three protocols, depending on the location and size of the defect.