HyaloFAST Trial for Repair of Articular Cartilage in the Knee

NCT ID: NCT02659215

Last Updated: 2023-06-22

Basic Information

• Recruitment Status: ACTIVE_NOT_RECRUITING
• Clinical Phase: NA
• Total Enrollment: 200 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2015-12-31
• Study Completion Date: 2026-06-30

Brief Summary

The purpose of this study is to evaluate the safety and efficacy of Hyalofast® scaffold with bone marrow aspirate concentrate (BMAC) compared to microfracture in the treatment of symptomatic cartilage defects of the knee.

Detailed Description

• Prospective, randomized, active treatment-controlled, evaluator-blinded (radiologist reviewer and physician evaluator) multicenter study (up to 40 sites in the US and EU).
• All subjects that meet preoperative screening eligibility criteria will be randomized to treatment with Hyalofast® with BMAC or Microfracture.
• Hyalofast® is a sterile, biodegradable non-woven pad (2 x 2 cm or 5 x 5 cm) that is composed of HYAFF-11®, a benzyl ester of hyaluronic acid. Hyalofast® acts as a biodegradable support for the autologous bone marrow aspirate concentrate. Hyalofast® is soft and conformable and can easily be cut to fit the lesion size.
• Autologous bone marrow is harvested from the subject intraoperatively during the Index Procedure. Approximately 60 mL of bone marrow will be aspirated from the subject's iliac crest using the SmartPrep 2 Bone Marrow Processing Pack. The cellular rich portion will be concentrated via the SmartPrep BMAC 2 Centrifuge System at point-of-care to provide 7 mL of bone marrow aspirate concentrate (BMAC). 1 - 2 mLs will be used for post-procedure testing of total nucleated cells, cell viability, and sterility.
• Hyalofast® with BMAC is implanted during either a standard knee arthroscopy or min-arthrotomy depending upon surgeon preferences and intra-operative findings. The lesion to be treated will be debrided to a stable cartilage margin. The defect will be sized and Hyalofast® will be cut to fit the lesion area. If necessary, more than one Hyalofast® pad can be overlapped to cover the lesion. 2 mL of BMAC will be loaded per Hyalofast® scaffold and then implanted to cover the defect. Hyalofast® with BMAC readily adheres to the site of application, but, if necessary, can be secured to the defect margins with an FDA-approved fibrin glue.
• All subjects will be assessed at intervals post-procedure (1 month, 3 months, 6 months, 12 months, 24 months, and 36 months).
• Subjects will be required to follow a strict pre-specified post-surgery rehabilitation protocol specific to the defect location.
• Measures to assess effectiveness will be conducted at follow-ups, with the primary effectiveness endpoint assessment done at the 24 month timepoint.
• Evaluators doing efficacy assessments of the subject and administering subject-reported outcome instruments will be blinded to the treatment.
• Safety will be assessed by the collection of adverse events at all timepoints.
• Magnetic Resonance Imaging (MRI) will be conducted at Screening, 1 month, 12 months, 24 months, and 36 months. Evaluation of the MRIs, including the MOCART score, will be done by blinded radiologist reviewers. The one month MRI will be used as the baseline MRI for evaluation of treatment effectiveness.

Conditions

Defect of Articular Cartilage

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: SINGLE

Study Groups

Hyalofast with BMAC

A hyaluronan-based scaffold (Hyalofast®) is utilized together with autologous bone marrow aspirate concentrate (BMAC) in a one-step arthroscopic/mini-arthrotomic procedure.

Group Type: EXPERIMENTAL

Hyalofast

Intervention Type: DEVICE

Implantation of Hyalofast scaffold with autologous bone marrow aspirate concentrate via arthroscopy/mini-arthrotomy.

Microfracture

Microfracture is an arthroscopic surgical technique involving placement of microfracture penetrations within the cartilage defect to provide stem cells and growth factors from the bone marrow to aid cartilage repair.

Group Type: ACTIVE_COMPARATOR

Microfracture

Intervention Type: PROCEDURE

Microfracture is a well-established arthroscopic surgical technique for cartilage repair which involves several systematic steps, including debridement to a stable cartilage margin, careful removal of the calcified cartilage layer, and homogeneous placement of microfracture penetrations within the cartilage defect, with resultant complete defect fill by a well-anchored clot

Interventions

Hyalofast

Implantation of Hyalofast scaffold with autologous bone marrow aspirate concentrate via arthroscopy/mini-arthrotomy.

Intervention Type: DEVICE

Microfracture

Microfracture is a well-established arthroscopic surgical technique for cartilage repair which involves several systematic steps, including debridement to a stable cartilage margin, careful removal of the calcified cartilage layer, and homogeneous placement of microfracture penetrations within the cartilage defect, with resultant complete defect fill by a well-anchored clot

Intervention Type: PROCEDURE

Eligibility Criteria

Inclusion Criteria

1. Patient is male or female, between 18 and 60 years of age

2. Patient's body mass index (BMI) is <35 kg/m2

3. Patient has a symptomatic lesion of the femoral condyle (medial and/or lateral) or femoral trochlea that is between 1.5 - 6 cm2 on screening images confirmed by the independent radiologist

4. The symptomatic lesion is classified as International Cartilage Repair Society (ICRS) grade 3 or 4

5. Patient agrees to actively participate in a strict rehabilitation protocol and follow-up program

6. Patient is using only nonsteroidal anti-inflammatory drugs or acetaminophen/paracetamol during the month before signing the informed consent form to treat knee pain

7. Patient is willing and able to provide informed consent and comply with study requirements

8. Patient, if woman of childbearing potential, must have a negative pregnancy test at Screening, cannot be lactating and is willing to use adequate contraception for the first 12 months of the study after the last surgery

9. Patient has ability to consistently rate knee pain and function as demonstrated by completion of total KOOS score

10. Patient has a minimum of 45 out of 100 Visual Analogue Scale (VAS) score for index knee pain when remembering index knee pain when not on medication and when active

11. Patient is willing to use other pain medication rather than Non-steroidal Anti-inflammatory Drugs (NSAIDS) for 6 months post-surgery (e.g. acetaminophen, or narcotic analgesics, if prescribed). Post-surgical use of aspirin for clot prevention is acceptable.

12. Patient is willing to restrict pain medication after 6 months post-surgery to NSAIDs or acetaminophen/paracetamol only through the end of the trial

13. Patient must have Hematocrit ≥ 28.0%; White Blood Cell count ≤ 14,000; Platelet Count ≥ 50,000; Creatinine ≤ 2.0 mg/dL; and International Normalized Ratio (INR) ≤ 1.6

Exclusion Criteria

1. Major concomitant cartilage lesions which require extensive surgical treatment. (Lesions such as minor loose bodies, small debris fragments, small cartilage fragments or prominent knee fat pad are allowed. These lesions may be treated with debridement).

2. Presence of a kissing bipolar lesion that is apposed to the index lesion and is deeper than Grade 2 (ICRS classification) as determined by MRI. (Presence of a kissing (bipolar) lesion that is apposed to the index lesion and is deeper than Grade 2 and is discovered under arthroscopy are allowed). The non-index lesion, if indicated for treatment, should be treated with the study assigned treatment of the index lesion.

3. Diagnosed advanced osteoarthritis as demonstrated by a Kellgren-Lawrence grade of 3 or 4 in the index knee

4. Complex ligamentous instability of the index or contralateral knee. (Previous reconstructions of Anterior Cruciate Ligament (ACL) or Posterior Cruciate Ligament (PCL) are allowed, of either the index or contralateral knee, if instability is not present. Grade 1 ligamentous injury are allowed)

5. Infections or skin diseases at target knee joint

6. Osteochondritis dissecans (OCD)

7. Patients requiring meniscal arrow or meniscal sutures

8. Previous meniscal transplant in the index knee

9. Patients with previous total or functional meniscectomy. (Patients with a previous partial meniscectomy and a meniscus that is considered biomechanically functional are allowed)

10. Varus or valgus malalignment exceeding 10° in either knee

11. Patient requiring concomitant surgical procedures at the time of Index Procedure such as osteotomies (e.g. high tibial valgus and/or patellar realignment osteotomy), bone subchondral perforation, ligament surgery, meniscal surgeries etc.

12. Previous cartilage repair procedure (microfracture, Osteochondral autograft transplantation system (OATS) or Autologous Chondrocyte Implantation (ACI) with or without use of a scaffold (matrix) in the index knee

13. Previous failed microfracture procedure in index knee. (Previous history of microfracture in the contralateral knee is allowed)

14. Known hypersensitivity (allergy) to hyaluronate

15. Contraindication(s) to microfracture surgery

16. Hyaluronic acid intra-articular injections into the index knee within the last 90 days before signing informed consent

17. Corticosteroid therapy by systemic or intra-articular route within the last 60 days before informed consent or intramuscular or oral corticosteroids within the last 30 days before informed consent.

18. Uncontrolled diabetes

19. Any concomitant painful or disabling disease of the spine, hips, or lower limbs, including the contralateral knee, that would interfere with evaluation of the index knee

20. Any clinically significant or symptomatic vascular or neurologic disorder of the lower extremities

21. Any evidence of the following diseases in the index knee: septic arthritis; inflammatory joint disease; gout; recurrent episodes of pseudogout; Paget disease of bone; ochronosis; acromegaly; hemochromatosis; Wilson disease; primary osteochondromatosis; heritable disorders; collagen gene mutations

22. Rheumatoid arthritis or gouty arthritis

23. Current diagnosis of osteomyelitis

24. Any result from screening blood work (including complete blood count, Prothrombin Time (PT)/Partial Thromboplastin Time (PTT)/INR, liver function, and creatinine) that exceeds 1.5x the upper limit of normal or is below 0.5x the lower limit of normal.

25. Diagnosed musculoskeletal cancer or any diagnosed cancer, other than musculoskeletal if not on long term remission (e.g. at least 5 years or negative biopsy at last exam), except basal cell carcinoma

26. Alcohol and drug (including medication) abuse

27. Patients who are at higher risk for post-surgical bleeding (e.g., bleeding disorder; taking anticoagulants except low dose aspirin) or post-surgical infection (e.g., taking immunosuppressants; have a severe infection or a history of serious infection)

28. Contraindications to MR imaging

29. Patient is currently receiving workman's compensation or disability or is in litigation for workman's compensation or disability claims

30. Participation in concurrent trials or in previous trial within 90 days of signing informed consent

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 60 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Anika Therapeutics, Inc.

INDUSTRY

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Alberto Gobbi, MD

Role: PRINCIPAL_INVESTIGATOR

OASI Bioresearch Foundation

Locations

Physicians Research Group

Tempe, Arizona, United States

Axis Clinical Trials

Los Angeles, California, United States

Kerlan-Jobe Orthopedic Clinic

Los Angeles, California, United States

BioSolutions Clinical Research Center

San Diego, California, United States

New Hope Research Development

Tarzana, California, United States

Orthopedic Foundation

Stamford, Connecticut, United States

Paramount Trials, LLC

Miami, Florida, United States

Suncoast Clinical Research

New Port Richey, Florida, United States

OrthoIllinois

Rockford, Illinois, United States

Bone and Joint Clinic of Baton Rouge

Baton Rouge, Louisiana, United States

Covington Orthopedic and Sports Medicine Institute

Covington, Louisiana, United States

Clinical Research Center of Nevada

Las Vegas, Nevada, United States

New York Presbyterian Hospital

New York, New York, United States

Ohio State University Wexner Medical Center

Columbus, Ohio, United States

Penn Medicine

Philadelphia, Pennsylvania, United States

Austin Ortho Biologics / Seton Medical Center Austin

Austin, Texas, United States

Baylor Scott & White

Temple, Texas, United States

Epic Medical Research

Murray, Utah, United States

University Hospital Tulln

Tulln, Lower Austria, Austria

Kepler University Clinic

Linz, Upper Austria, Austria

Krankenhaus der Barmherzigen Schwestern

Ried, Upper Austria, Austria

Medical University of Graz

Graz, , Austria

Universtitatsklinkik Krems

Krems, , Austria

Medical University of Vienna

Vienna, , Austria

Evangelisches Krankenhaus

Vienna, , Austria

Private Hospital Doebling

Vienna, , Austria

Ortopeedia Arstid AS

Tallinn, , Estonia

North Estonia Medical Center

Tallinn, , Estonia

Health Center of Downtown-Lipotvaros, Orthopedic Outpatient Clinic (Belvárosi-Lipótvárosi Egészségügyi Szolgálat Ortopeadia)

Budapest, , Hungary

Semmelweis Egyetem Orthopaedic Clinic (Ortopédiai Klinika)

Budapest, , Hungary

Uzsoki Hospital, Department of Traumatology

Budapest, , Hungary

Jutrix Medical Llc

Budapest, , Hungary

Menta Egeszsegkozpont Kft.

Budapest, , Hungary

Magyar Honvedseg, Egeszseugyi Kozpont, Balesteti Sebeszeti Osztaly

Budapest, , Hungary

DE KK Ortopediai Klinika

Debrecen, , Hungary

Somogy Megyei Kaposi Mór Oktatókórház

Kaposvár, , Hungary

Kastelypark Klinka

Tata, , Hungary

Medistra Hospital

Jakarta, , Indonesia

Royal Progess Hospital

Jakarta, , Indonesia

Instituto Ortopedico Rizzoli

Bologna, , Italy

A.O. Universitaria San Martino Monoblocco

Genova, , Italy

University Federico II

Naples, , Italy

AB "Ortopedijos technika"

Kaunas, , Lithuania

Vilnius University Hospital Santaros klinikos

Vilnius, , Lithuania

Desarrollo Ético en Investigación Clínica S.C.

Guadalajara, , Mexico

Cruz Roja Mexicana (Hospital de Ortopedia de la Cruz Roja Mexicana)

Mérida, , Mexico

Hospital Universitario Dr. José Eleuterio González

Monterrey, , Mexico

De La Salle Medical and Health Sciences Institute

Cavite, , Philippines

Countries

United States; Austria; Estonia; Hungary; Indonesia; Italy; Lithuania; Mexico; Philippines

References

Shah SS, Lee S, Mithoefer K. Next-Generation Marrow Stimulation Technology for Cartilage Repair: Basic Science to Clinical Application. JBJS Rev. 2021 Jan 19;9(1):e20.00090. doi: 10.2106/JBJS.RVW.20.00090.

Reference Type: DERIVED

PMID: 33512974 (View on PubMed)

Other Identifiers

Hyalofast 15-01

Identifier Type: -

Identifier Source: org_study_id