Grant: Collaborative Health Research Projects (NSERC partnered)

"Articular cartilage injuries, particularly in the knee, can lead to long-term damage and severe loss of joint function. Unlike many tissues, articular cartilage is not vascularized and does not naturally repair when damaged, so surgical intervention is often required. Total joint replacement is not acceptable for younger, active patients because the implanted prosthesis doesn't permit a return to full activity. But a cartilage replacement operation can result in a much improved quality of life and can delay or eliminate the eventual need for joint arthroplasty. Several methods of cartilage replacement exist, but none is wholly satisfactory. One method is mosaic arthroplasty, in which osteochondral plugs from non-load-bearing areas of the joint are transplanted to the defect site. The variable patient outcomes reported for mosaic arthroplasty are likely due to the high technical complexity of planning and performing the surgery. We hypothesize that Computer-Assisted Mosaic Arthroplasty (CAMA) will overcome these problems and will lead to better patient outcomes and a reduction in healthcare costs. Our group has extensive experience in this area and has already validated two methods of CAMA in an in-vivo animal study with promising results. The proposed three-year project will determine the feasibility of CAMA in humans. We will develop three CAMA methods: All three will use a pre-operative computer planning stage to determine the optimal pattern of osteochondral plugs at the defect site and the locations from which those plugs can be harvested. One method will use opto-electronic tracking of the surgical tools to guide them according to the surgical plan in an open-knee operation. The second method will use patient-specific templates that fit tightly to the exposed bone and which contain slots to guide the surgical tools according to the surgical plan. The third method will use minimally-invasive arthroscopy with opto-electronic tool tracking; this method requires a more sophisticated planning stage due to the limited arthroscopic access to the joint surface. All CAMA methods will first be validated on artificial knee models, then on a limited number of human patients in a pilot trial. This project will train three MSc students, one PhD student, four surgical residents, two undergraduates, and one research associate in a multidisciplinary environment at Queen's University and Kingston General Hospital. "