mechanical vs. radiofrequency-based debridement in the treatment of articular cartilage lesions

Conditions: Chondral Lesion Plus Partial Medial Meniscectomy

Summary: the purpose of this study is to evaluate changes in clinical and imaging outcomes following arthroscopic treatment of a single medial femoral chondral lesion plus partial medial meniscectomy by radiofrequency-based debridement or mechanical debridement in subjects ≥ eighteen (18) years of age.

this is a non-inferiority, prospective, double blinded, multi-center, randomized, controlled, adaptive study design with enrollment of 82 randomized subjects at up to 13 study sites. study duration will be until the last subject enrolled reaches 104 weeks post-operative. the study will be comprised of two parts: part i: part i will require all investigators perform 1 to 3 procedures using the quantum 2 controller plus paragon t2 icw wand or the werewolf controller plus flow 50 wand. investigators must be qualified by training to perform procedures prior to use of either study device. this purpose of part i will be to minimize variability with the recommended directions for use established in the instructions for use (ifu). part i subjects will be followed per protocol follow-up requirements, and will be included in the safety population only. these subjects will be additive (to the safety population) to the 82 randomized subjects planned as part of the primary evaluation in part ii. part ii: part ii will consist of 82 randomized subjects. each investigator may initiate enrollment of subjects in this part of the study following completion of part i requirements. the part ii study implements a randomized adaptive study design, whereby an interim analysis will be conducted for sample size re-assessment. there is no intention of reducing the sample size as a result of this interim analysis; however, the sample size may be increased to either establish the non-inferiority and/or may be increased sufficiently to establish superiority depending on the results of the interim analysis.

Eligibility criteria:
inclusion criteria subjects must meet all of the following criteria to be included in the study: 1. given written informed consent on the irb/reb approved consent form specific to the study, prior to study participation 2. is male or non pregnant female ≥ eighteen (18) years of age 3. mri within 9 months of enrollment into this study confirming presence of a medial femoral chondral lesion and medial meniscal tear requiring a partial meniscectomy (as determined by the investigator) 4. must present with pain in the index knee of moderate or severe (\> 30 mm) as measured by the vas 5. must be able to understand english (written and oral) 6. must be available to come to all study related visits and is physically and mentally willing and able to comply with all post-operative evaluations 7. must be in general good health (as determined by the investigator) based on screening assessments and medical history intra-operative inclusion criteria subjects must meet all of the following criteria to be included in the study: 1. arthroscopic confirmation of a lesion requiring treatment meeting the following parameters: 1. single, treatable chondral lesion, localized to the medial femoral condyle, 2. icrs grade 2 with widely displaceable fibrillation or flaps or grade 3a, 3. \< 4cm2 in size exclusion criteria subjects will be excluded from the study, if they meet any one (1) of the following criteria: 1. body mass index (bmi) \> 40 or index joint pain is due to bmi (as determined by investigator) 2. requires bilateral knee surgery 3. any of the following conditions: 1. active joint infections 2. is immunocompromised, has sickle cell disease, has a primary bone disease (e.g., paget's disease) or disorders that may adversely affect the healing process, or is terminally ill 3. inflammatory rheumatoid arthritis or other systemic inflammatory arthritis (i.e., gout) 4. metastatic and/or neoplastic disease 5. infectious, highly communicable diseases (e.g., active tuberculosis or active hepatitis) 6. coagulation disorder or patient is receiving anti-coagulants 7. documented evidence of a history (e.g. liver testing) of drug/alcohol abuse within 12 months of enrollment into this study 8. diagnosed with a behavioral condition which could affect their ability to accurately comply with the study (e.g. developmental delay, attention deficit disorder, and autism) 4. any of the following conditions in the index limb or joint: 1. grade iii or greater osteoarthritis as determined by ap radiograph (kellgren-lawrence classification) 2. systemic steroid therapy or steroid intra-articular therapy within 4 weeks of enrollment into this study 3. intra-articular viscosupplementation within 3 months of enrollment into this study 4. osteomyelitis, septicemia, or other infections that may spread to other areas of the body 5. fractures, osteocysts or osteolysis 6. recurrent patellar instability (e.g., subluxation or dislocation) 7. severe varus or valgus knee deformities (as determined by investigator) 8. symptomatic tear of the lateral meniscus 9. avascular necrosis 10. synovial disorders (e.g., pigmented villanodular synovitis) 11. previous total or partial meniscectomy 12. requires reconstruction or replacement of medial or lateral meniscus 13. knee instability, malalignment, or patellar tracking dysfunction 14. prior treatment for cartilage repair, including but not limited to aci, mosaicplasty and/or marrow stimulation procedures 15. prior knee tendon and/or ligament repair or patellar surgery within 6 months of enrollment into this study 5. any of the following conditions in the contralateral limb or joint: 1. greater than minimal abnormality as shown by clinical exam and/or imaging 2. scheduled or to be scheduled for surgery over the course of this study 3. involvement causing abnormal ambulation and non-compliance with post-operative rehabilitation guideline 6. the subject has implanted metallic devices (insulin pumps, nerve stimulators, etc), medically implanted clips or other electronically, magnetically or mechanically activated implants that would contraindicate undergoing an mri scan of the knee 7. the subject has claustrophobia that would inhibit their ability to undergo an mri scan of the index knee 8. receiving prescription narcotic pain medication for conditions unrelated to the index knee condition 9. cardiac pacemaker or other electronic implant(s) 10. pregnant and/or intending to become pregnant during this study period 11. participated in a clinical study within 30 days of enrollment into this study, or who is currently participating in another clinical study. 12. is a prisoner, or is known or suspected to be transient 13. is involved with worker's compensation unrelated to the index knee 14. is involved with health-related litigation intra-operative exclusion criteria subjects will be excluded from the study, if they meet any one (1) of the following criteria: 1. has more than 1 chondral lesion requiring treatment 2. requires concomitant procedures (i.e., anterior cruciate ligament repair, high tibial osteotomy), excluding partial medial meniscectomy 3. has a medial meniscal tear not requiring treatment 4. has a medial meniscal tear requiring a procedure other than partial meniscectomy 5. has a lateral meniscal tear requiring treatment

Keywords: articular cartilage cartilage lesion cartilage defect radiofrequency debridement cartilage coblation knee meniscus meniscectomy mr imaging mechanical debridement mechanical shaver torn meniscus arthroscopic knee surgery damaged cartilage