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PHOTO COURTESY OF CRYSTAL CLINIC ORTHOPAEDIC CENTER, AKRON OH basketball. An MRI revealed cartilage loss, but no bone loss. "Cartilage loss in a child's or adolescent's weight-bearing area of the knee can cause osteoarthritis within five to ten years," Dr. Fleissner explains. "So it's important that it be repaired." In the past, this was done in a 2-stage procedure. Stage one involved harvesting the cartilage to send to a lab to grow in culture. Stage two occurred about six weeks later, after the lab returned the prepped cartilage for implantation. Dr. Fleissner points out that this isn't ideal — not only because the patient has to undergo two operations, but because lab- prepared cartilage cells lose their phenotype. "That's not good. We hope that the cells will return to their normal type/normal cartilage when they're put back into the body, but we don't know that for sure," he says. With the Reveille, that problem is avoided because the implant- able tissue is created and implanted within minutes of harvesting. "There's not a bunch of repeated generations in a culture dish, so we think (with the Reveille) it's going to stay the same type, instead of losing that normal cartilage type," says Dr. Fleissner. The process begins with harvesting the cartilage in the usual way. (For Dr. Fleissner's 16-year-old patient with the cartilage loss in the knee, the cartilage was obtained from the distal femur in a non-weight bearing area, called 'the notch'.) The tissue is then placed in the Reveille Cartilage Processor, which is a cylindrical device consisting of two blades, a sieve, and removable tissue reservoir. "The blades spin very fast and process the cartilage into 1 mm pieces which are filtered through saline," explains Dr. Fleissner. "After the tissue is processed — it only takes two minutes — we implant it right into the area where there's cartilage loss and cover it with fibrin glue to seal it. We also add PRP, (platelet-rich plasma), because it has the growth factors that help cartilage heal and grow. So we give the graft a little nutrition to kind of jump start it." For the past several years, Dr. Fleissner has been conducting clinical research on biologic methods to improve graft healing. The use of PRP is one of those methods. And it's showing promise. The entire single-stage procedure only takes about one hour. According to Dr. Fleissner, the surgery is relatively painless if done arthroscopically. "Most of the time cartilage repair in the knee is done with an arthroscope," says Dr. Fleissner. "If the defect is on the back of the knee cap, then we do have to make a bigger incision, so that's a little more painful." Afterwards, the patient must remain non weight-bearing on the repaired limb for six weeks to allow the graft to heal. "We want them to move the limb, because that's good for the cartilage, but they're not allowed to walk on it for six weeks. And then they do rehab. It's usually six months before they can participate in sports," he says. In the past eight months, Dr. Fleissner has used the Reveille to perform 15 single-stage autologous chondrocyte implantations The Reveille Cartilage Processor creates autologous tissue grafts in the OR immediately after the cartilage is harvested, so it can be implanted within minutes. M D N E W S . C O M /// M D N E W S C L E V E L A N D /A K R O N / C A N T O N ■ N O V E M B E R / D E C E M B E R 2 017 0 7 PHOTO © SMITHBERGER PHOTOGRAPHY, NORTH CANTON OH