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Author Topic: 'Bioguide' membrane instead of Periosteum eliminates overgrowth?  (Read 5956 times)

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Offline David3

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I had ACI / TTO in late July 2007. My OS, Dr Minas, elected to use a porcine membrane over my grafts instead of using my own periosteum. He also refers to this type of membrane as 'Bioguide'; it is apparently from a pig, and is cleansed and treated before ACI use. At the time of my surgery, he quoted studies from Europe which showed that use of Bioguide virtually eliminated periosteal overgrowth (overgrowth results in the need to scope about 25% of ACI patients at around the 4-6 month mark). He also said that Bioguide was potentially stronger than periosteum, particularly for patients who have thin periosteum. Increased membrane strength obviously reduces the chance of compromising the graft early on, aswell as increasing 'workability' for the surgeon.  A further advantage is a shorter incision - no need to harvest periosteum from your shin. I believe I was the third patient on whom he'd used Bioguide.

I saw my OS last week, ironically for a scope to remove adhesions, rather than overgrowth. He mentioned that he is now using Bioguide for all his ACI patients. He has now performed 40 ACI operations using Bioguide, and has had no instances of overgrowth. He believes ACI graft overgrowth has probably been eliminated.

Thought I'd share this for patients who are contemplating ACI. May be worth enquiring about.

2006: Left Knee (LK) microfracture (MFC, LFC, Trochlear), failed at 6 months
7/07: ACI/TTO of LK (MFC, LFC, trochlea, patella)
2014: Considering ACI treatment on RK.

Offline MegTX

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Re: 'Bioguide' membrane instead of Periosteum eliminates overgrowth?
« Reply #1 on: March 18, 2008, 02:04:59 AM »
Very cool.  I'm pretty sure my OS used periosteum, that's what he was describing to me... but he said he works with Dr. Minas, so he will probably start doing the same thing if the results are better.

Though we are apparently fighting adhesions, so we won't have a clue yet about overgrowth.  :-(

But it's good to know they're making refinements to the procedure, since I will likely have to have my other knee done as soon as this knee is completely stable.
Lateral Release, Medial "Reef" - '91
{16 years of grinding, pain, swelling and lots of ice}
'scope 7/07 - .7cm2 tibial plateau microfracture, 2.5cm2 grade4 patellar CP debridement
ACI & Fulkerson TTT 2/08 (patella lesion then 4.5cmx3cm)

Offline casey2291

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Re: 'Bioguide' membrane instead of Periosteum eliminates overgrowth?
« Reply #2 on: March 18, 2008, 10:58:19 PM »
My OS used horse pericardium instead of using my own periosteum.  I wonder if it has the same effect to eliminate overgrowth.  Just had a scope to deal with adhesions, but I don't believe I had any overgrowth. 
LOA #2 and hardware removal 12/15/08-new cartilage from ACI looks "GOOD"
LOA on left knee 3/18/07
ACI and HTO on left knee 10/22/07
scope of right knee on 6/21/07
microfracture left knee 3/18/05

Offline Chondrosoldier

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Re: 'Bioguide' membrane stretches to prevent mushroom effect of overgroth
« Reply #3 on: March 26, 2008, 04:26:47 PM »
From the little I know about tissue dynamics, the main advantage to these pericardium and pig membrane eliminating overgrowth is not only their strength but their elastic properties.  of pericardium and pig membrane are superior to that of human periostium.  Similarly, our cells are reproduced in nothing other than pig fetus.

With normal human periosteum, there tends to be a mushroom effect where the periosteum is oversewn to the healthy surrounding cartilage.  With tensile tissue such as pericardium, that effect is minimalized.    Overgrowth is a lot more prevalent on the trochlea and patella then the femur.

Adhesions more or less come with getting rusty post-operatively due to the disruption of the synvovial properties from the massive surgery and long period of limited mobility.  Kissing lesions can be especially troublesome because the periosteal surfaces are coming in contact with eachother with limited lubrication.  This will improve as the surgery is made less invasive and recovery times are improved.  Surgeries such as CaReS are a good example.
« Last Edit: March 26, 2008, 04:35:11 PM by Chondrosoldier »
1997 L Traumatic dislocation/ACL
1997-2001 L recurrent sbuluxation
2001 L TTT Realignment
2006 L Patellar Carticel biopsy/debridement
2006 L Carticel 4cm patellar reimplantation
2007 R Carticel biopsy/debridement
 Insurance Battle
2008 R TTT 4CM Patalla/3CM Trochlea Carticel implant

Offline markld

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Re: 'Bioguide' membrane instead of Periosteum eliminates overgrowth?
« Reply #4 on: March 23, 2009, 04:58:37 PM »
I just had aci with biogide on 3-6-09 by Dr. mandelbaum in Santa Monica.
My lesion is 1.5 cm2 and located in the Trochlea.
My question to you is; How is your knee post op, and how large and where was the lesion located in your knee.
From everything I have read the Biogide is far superior to the periosteum in every aspect.

April 2008 microfracture left knee trochlea
Jan 2009 ACI harvest from right knee
Mar 2009 ACI right knee trochlea
July 2009 Aci left knee
Nov 2009 left knee scope to check graft