STUDY: ACI versus Microfracture – no difference

AUTOLOGOUS CHONDROCYTE IMPLANTATION AND MICROFRACTURE: NO DIFFERENCE (Orthopedics This Week)
A randomized trial from several Norwegian facilities is indicating that the in vitro cultivation of autologous chondrocytes is not an improvement over microfracture. Researchers enrolled 80 patients with a single symptomatic chronic cartilage defect on the femoral condyle without general osteoarthritis (OA).
Gunnar Knutsen, M.D., Ph.D., a co-author on the study, told OTW, “At 15 years follow-up, we found no significant clinical differences between the autologous chondrocyte implantation (ACI) and the microfracture groups. We did find, however, that 57% of the surviving patients in the ACI group and 48% of such patients in the microfracture group had radiographic evidence of early osteoarthritis.
“Orthopedic surgeons from four university clinics in Norway planned the study in 1998. We wanted to compare a new tissue engineering technique: ACI with a low cost arthroscopic technique: microfracture. This study was an important part of my Ph.D. on cartilage repair.
“We are still not able to regenerate hyaline articular cartilage in adults, and the frequency of osteoarthritis following cartilage surgery is problematic in the long run. In vitro cultivating of autologous chondrocytes for implantation is not proven to be better than microfracture. Since we started the trial, newer generations of both techniques have been introduced, however so far none of these newer generations are proven to be superior.
“There is a need for improvements—and hopefully tissue engineering of cartilage will be successful. Low cost marrow stimulation techniques should still be the first line treatment for contained defects if surgery is indicated.
“In many cases conservative options should be offered before surgery. Arthroscopic surgery in general is debated for degenerative joint disease like early OA and meniscus. However, younger patients with symptomatic cartilage lesions or osteochondral lesions including OCD often needs surgery—and arthroscopic low cost surgery should be our first option.”

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6 Questions with Herb Schwartz, a quietly disruptive force in sports medicine and early OA

This is the sixth in a series of the 6-Question interviews with the leaders who are challenging conventional thinking in Orthopedics. (read other interviews here)

Herb Schwartz has been a quietly disruptive force in the orthopedics industry for decades. He has been innovating in tissue engineering, biologics, sports medicine, and orthopedic implants/instruments and has accumulated 37 patents.  I met Herb Schwartz shortly after he left DePuy and founded Schwartz Biomedical in 2004. He later successfully sold his BioDuct meniscus repair technology to Stryker. Today, his new technology company, BioPoly, is quickly gaining traction.
I sat down with Herb to ask him a few questions.
1. Before we get into BioPoly, tell me how you ventured from your doctoral work to GE Aircraft and arrived at orthopedic innovation.
I began my career at GE Aircraft Engines which gave me a strong technical, manufacturing, and business basis because of the successful business practices of GE. From LEAN manufacturing to Six Sigma to advanced materials, GE’s leadership training provided me with the necessary tools to be successful in nearly any industry, including orthopaedics. With GE’s support, I was able to pursue my true passion in the biomedical field by completing my Masters and Ph.D. work in Biomechanical Engineering at the University of Cincinnati. With my education complete, I began my orthopaedics career at DePuy Orthopaedics and was blessed to work with an amazing group of people who challenged me to innovate and develop products in orthopaedics.
2. What was the genesis of BioPoly? Where did the idea come from and how did you get it started?
The initial material was invented by a very intelligent professor (Dr. Sue James) from Colorado State University. I formed the BioPoly® company and obtained the exclusive worldwide license for all medical applications of this technology because I believed that this unique material could actually change the direction of orthopaedics. However, I knew it would require a very, very long road to get to the market. So, with the initial technology in hand, we started down the path of developing this very interesting material for use in orthopaedic applications. The initial funding for BioPoly® came from grants from the State of Indiana, the 21 Fund. Early on, my vision for BioPoly® was validated by one of the pillars of orthopaedic industry, the late Dr. Dane Miller. Dane was the industry expert on the grant committee that decided to provide the initial funding for BioPoly and told me that he believed this material had the potential to disrupt the industry. I obviously still agree with that today. In fact, I am so convinced of this fact that with the help of many hardworking and intelligent people surrounding me and with the help of committed investors, we have built an orthopaedic company on this platform technology. The BioPoly team members have changed over the years, but everyone who has touched the technology has contributed to its success. I am very proud of our team and what they accomplished as we developed this technology to the point where it is now ready for “prime time.” We continue to surpass major milestones as we are selling in the marketplace and developing and launching new applications. We have multiple product lines that are CE marked and that are being sold outside the US, and we are working toward entering the US market very soon.

3. What is the technology behind BioPoly and how does BioPoly work clinically?
The BioPoly® concept is actually very simple, although the technology itself is somewhat complicated. Essentially, BioPoly is a self-lubricated plastic material. The proper material designation for BioPoly is that it is a microcomposite of hyaluronic acid (the “Bio” portion of BioPoly) and ultrahigh molecular weight polyethylene, UHMWPE (the “Poly” portion). The “lubrication” comes from the hyaluronic acid ingredient, a component of synovial (joint) fluid. That lubrication coupled with UHMWPE (the same bearing material used in total joint applications) is what provides the backbone of the BioPoly material technology. So, basically what we have is a hydrophilic (water attracting) polymer that we call BioPoly®. The hyaluronic acid is permanently held within the polyethylene matrix, and when placed in a joint (knee, shoulder, hip, etc…) environment, it takes advantage of the surrounding synovial fluid by holding onto it during joint motion, ensuring that a layer of lubricant is between BioPoly® and whatever it is articulating with. So, an implant created from the BioPoly material has a true market advantage. When used clinically, the lubricating properties of hyaluronic acid along with the robustness of UHMWPE make the BioPoly material extremely biocompatible with orthopaedic tissues like cartilage and meniscus because BioPoly implants can carry anatomical loads yet not damage opposing soft-tissue surfaces.

4. So who is the ideal patient for BioPoly?
In the knee, the ideal BioPoly® patient is an active person who has a focal cartilage defect but is too young for a uni or total knee and too old for his/her biology to provide a predictable outcome from one of the biological fixes available.  We have been implanting for almost 5 years with patient’s ages ranging from 21 to 71+ years old. The common theme that we have in our outcomes is that patients become pain-free and active very quickly. This is because the BioPoly implants are designed to allow immediate weight bearing. In fact, we recommend immediate weight bearing because load and articulation maintain healthy subcondral bone and overall for optimal joint health. So the BioPoly® patients don’t have to go through the long and painful rehab that is required by the biological treatments such as ACI or microfracture.
5. How is BioPoly different from other early OA treatments such as  ArthroSurface HemiCAPs, cartilage repair technologies or micro fracture?
When comparing BioPoly to other treatments, our clear advantage stems from the BioPoly material and the design of the implants, of which we have multiple issued and pending patents. BioPoly RS Knee implants share the same indication as microfracture in the knee; therefore, as we consider competition, we need to look at microfracture as well as other biologic approaches, including ACI, mACI, OATS, and allografts. Since BioPoly is an implant, we have very predictable outcomes, and in our case, they are very positive. The BioPoly implants and surgical technique work together so that BioPoly implants share anatomical loads with the surrounding cartilage; thus, the adjacent cartilage is not overloaded or under-loaded and the opposing cartilage has the proper loading during articulation as well. The loading environment provided by the BioPoly material stiffness and surgical technique along with the “self-lubrication” inherent in the BioPoly material are what provide the positive outcomes that we’ve been consistently seeing since we started to implant almost 5 years ago. With the help of prestigious surgeon investigators in the UK, a cohort of BioPoly patients are being followed in a proper registry studys so, these outcomes are based on real patient clinical data, not just anectdotal observations.  So, post-operative rehab is very minimal for our BioPoly patients which is a strong contrast to the biologic treatments. These treatments require weeks or even months on crutches followed by months of limitations and rehab. On the other hand, most of our patients are reporting to be pain free and full range of motion before 6 weeks. Many of our patients have regained their active lifestyles and are walking, hiking…even running, playing rugby, biking, skiing, and CrossFit training. Besides these positive outcomes, BioPoly also is very reliable. With a revision rate around 1%, we don’t even compare to the nearly 30% revision rate reported in most biologics.
When we compare BioPoly implants to all-metal implants, our main advantage is that we have material properties that better simulate cartilage properties.  Metal has the opposite property, it’s hydrophobic (repels water). The best lubricant for a hydrophilic surface like cartilage and BioPoly is the water-based synovial fluid. Unfortunately for (hydrophobic) metal placed in the joint, the best lubricant (oil) is not present. Besides the hydrophilic/hydrophobic property mismatch, the metal that our competitors use for articulating with cartilage is approximately 25,000x stiffer than cartilage; BioPoly is only 80x; so, no matter where you position the metal implant in the cartilage bed, it will end up carrying more load than it should. Articulating metal against cartilage has been shown in multiple animal studies to cause premature breakdown of the opposing cartilage due to overloading conditions. These metallic implants will transmit these higher loads to the subchondral bone beneath the implant and could also cause overloading conditions for the subchondral bone as well.
6. What are the current applications for BioPoly and where are you going in the future?
The current applications that are CE marked include the BioPoly® RS Partial Resurfacing Knee (femoral condyle and trochear facets), Patella, and Shoulder families of implants. Additional partial resurfacing implants are being developed currently, and our pipeline is very full with new applications throughout other joints, i.e. hip, ankle, great toe, etc… In addition to partial resurfacing (where BioPoly® articulates with cartilage), we are also optimizing the material for use in total joint applications, where BioPoly® replaces the UHMWPE bearing and articulates with metal. Since we can cross link the poly portion of BioPoly®, we have seen reductions in wear rate of 30-40% when comparing to highly crosslinked UHMWPE. Our process also allows for anti-oxidant treatment; therefore, I am very excited about the future of BioPoly® in these types of applications.
For more information about BioPoly click here [www.biopolyortho.com] or email us at [email protected].
BioPoly, LLC
7136 Gettysburg Pike
Fort Wayne, Indiana 46804

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Alphatec Spine reduces workforce by 20%

Alphatec Holdings Announces Company Updates (press release)

CARLSBAD, Calif., Oct. 05, 2016 (GLOBE NEWSWIRE) — Alphatec Holdings, Inc. (Nasdaq:ATEC), the parent company of Alphatec Spine, Inc., a provider of spinal fusion technologies, today announced changes to the Company’s executive leadership team, a reduction in the Company’s workforce and an inducement award granted to Craig Hunsaker, the Company’s newly appointed Executive Vice President, People & Culture.
Changes to the Executive Leadership Team and Reduction in Workforce
Michael O’Neill, Alphatec’s Chief Financial Officer and Treasurer, has resigned effective October 5, 2016.  Dennis Nelson, the Company’s Vice President of Finance and Corporate Controller, a position he has held since 2011, will serve as the interim principal financial and accounting officer for filings under the Securities Act of 1933 and the Securities Exchange Act of 1934, while the Company executes its search for a Chief Financial Officer.
In addition, today the Company reduced its workforce by approximately 20%.  This reduction in force is a significant part of a broader plan, which the Company has previously outlined, to reduce operating expenses by $20 million following the sale of its international business to Globus Medical and to more appropriately size the Company’s resources to better reflect the needs of a U.S.-focused organization.
“I would like to thank Mike for all of his contributions to Alphatec over the past six years,” said Leslie H. Cross, interim Chief Executive Officer of Alphatec Spine. “Today we have a stronger financial foundation — a much improved balance sheet and enhanced liquidity – that positions us to build to a high quality U.S.-focused business in the future.” Mr. Cross continued, “Dennis is a talented and experienced financial leader. Given his intimate knowledge of Alphatec and our financials, we are confident that Dennis will do an excellent job as we engage in our search for a CFO. We wish Mike all the best in his future endeavors.  I would also like to express my appreciation to each of the employees affected by today’s announcement for their dedication and many contributions to Alphatec over the years.”
Inducement Award Granted
The Company has granted restricted stock units (RSUs) and performance stock-based awards (PSAs) to Craig Hunsaker, Alphatec’s newly appointed Executive Vice President, People & Culture. These inducement awards were approved by the Compensation Committee of the Alphatec Board of Directors on October 4, 2016, with an effective date of October 5, 2016, and granted as an inducement material to Mr. Hunsaker entering into employment with Alphatec in accordance with NASDAQ Listing Rule 5635(c)(4) under Alphatec’s 2016 Employment Inducement Award Plan (the “Plan”).  The Plan was approved by Alphatec’s board of directors on October 4, 2016 and has a share reserve of 350,000 shares.
Effective October 5, 2016, Alphatec granted Mr. Hunsaker 173,322 RSUs and $750,000 (at target) of PSAs. The RSUs will vest in equal installments on each of the first three anniversaries of September 14, 2016, subject to Mr. Hunsaker’s continued service with Alphatec through the applicable vesting date. In addition, the RSUs will fully vest upon a change in control of Alphatec. The PSAs will vest in a dollar amount representing between 0% to 250% of the target value upon the earlier of September 14, 2019 or a change in control of Alphatec, subject to Mr. Hunsaker’s continued service with Alphatec through the applicable vesting date. The actual payout amount will be based on the Company’s market capitalization on the vesting date and the fair-market value of the Company’s common stock on such vesting date and will be paid in shares of Alphatec common stock.
Alphatec is providing this information in accordance with NASDAQ Listing Rule 5635(c)(4).
About Alphatec Spine
Alphatec Spine, Inc., a wholly owned subsidiary of Alphatec Holdings, Inc., is a medical device company that designs, develops and markets spinal fusion technology products and solutions for the treatment of spinal disorders associated with disease and degeneration, congenital deformities and trauma. The Company’s mission is to improve lives by delivering advancements in spinal fusion technologies. The Company and its affiliates market products in the U.S. via a direct sales force and independent distributors.
Additional information can be found at www.alphatecspine.com.
Forward Looking Statements
This press release may contain “forward-looking statements” within the meaning of the Private Securities Litigation Reform Act of 1995 that involve risks and uncertainty. Such statements are based on management’s current expectations and are subject to a number of risks and uncertainties that could cause actual results to differ materially from those described in the forward-looking statements. Alphatec Spine cautions investors that there can be no assurance that actual results or business conditions will not differ materially from those projected or suggested in such forward-looking statements as a result of various factors. Forward-looking statements include references to the Company’s: product development pipeline and product portfolio; ability to streamline its cost structure; ability to improve its balance sheet and liquidity; and ability to accelerate its revenue growth or grow its revenues at all.   Please refer to the risks detailed from time to time in Alphatec Spine’s SEC reports, including its Annual Report Form 10-K for the year ended December 31, 2015, filed on March 15, 2016 with the Securities and Exchange Commission, as well as other filings on Form 10-Q and periodic filings on Form 8-K. Alphatec Spine disclaims any intention or obligation to update or revise any forward-looking statements, whether as a result of new information, future events, or otherwise, unless required by law.
CONTACT: Investor/Media Contact:
Christine Zedelmayer
Investor Relations
Alphatec Spine, Inc.
(760) 494-6610
[email protected]

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Amedica reduces workforce by 38%

Amedica Provides Business Update (press release)
SALT LAKE CITY, UT — (Marketwired) — 10/06/16 — Amedica Corporation (NASDAQ: AMDA), a biomaterial company that develops and commercializes silicon nitride for biomedical applications, today provided a business update related to its business strategy and certain recent developments.
Briefly, the updates relate to the following items:

New patent directed to a threaded design in ceramic implants;
Participation at the annual International Society for Technology in Arthroplasty; and
Update related to completion of the company’s strategic workforce reduction.

Amedica Awarded Key Patent Protection for Threaded Implant Design Feature
Amedica was recently awarded a patent by the United States Patent and Trademark Office for “threading sinterable materials,” such as silicon nitride and other ceramic materials. U.S. Patent No. 9,399,309, covers methods for threading ceramic materials used for spinal fusion implants, or other biomedical implants. Threading technology is broadly applicable in a wide range of current medical devices made from PEEK or titanium, and this patent is the first for ceramic materials. Amedica’s ability to manufacture threaded biomedical implants made of silicon nitride and other ceramic materials reflects nearly five years of pioneering work by its R&D and engineering teams.
Amedica has implemented this new technology across its portfolio of Valeo® II spinal fusion devices. These fusion devices are made of micro-composite silicon nitride, which favors bone ingrowth and shows antibacterial properties, when compared to competitive PEEK and titanium implants. Valeo II silicon nitride interbody fusion devices are readily imaged on x-rays, CT, and MRI scans; a property unique to Amedica’s silicon nitride technology.
Amedica to Present Research Supporting Silicon Nitride at ISTA
Amedica announced that it will be presenting four papers at the International Society for Technology in Arthroplasty’s (ISTA) 29th Annual Congress occurring October 5-8, 2016 in Boston, Massachusetts. “These papers provide further evidence for the advantages of our proprietary silicon nitride composition in the spine, dental, and arthroplasty markets,” said Dr. Sonny Bal, Chairman and CEO of Amedica Corporation. “Our strength in manufacturing, research, and external collaborations is critical to creating long-term value, even as we reduce costs and address spine sales,” added Dr. Bal
Going Forward Following Strategic Reductions in Workforce
The company also confirmed that the previously-announced work force reduction has been completed, resulting in a leaner and more agile organization that is better positioned to extend its cash runway and execute on its strategic objectives.
Dr. B. Sonny Bal, chairman and chief executive officer of Amedica, stated, “despite the recent 38% reduction in force, the company continues to be in a strong position to timely and efficiently manufacture its silicon nitride products, further scientific research into the properties of our silicon nitride ceramic and how to enhance those properties, and to continue to support its external partnerships and product development opportunities.”
About Amedica Corporation
Amedica is focused on the development and application of interbody implants manufactured with medical-grade silicon nitride ceramic. Amedica markets spinal fusion products and is developing a new generation of wear- and corrosion-resistant implant components for hip and knee arthroplasty as well as dental applications. The Company’s products are manufactured in its ISO 13485 certified manufacturing facility and through its partnership with Kyocera, one of the world’s largest ceramic manufacturers. Amedica’s FDA-cleared and CE-marked spine products are currently marketed in the U.S. and select markets in Europe and South America through its distributor network and its growing OEM and private label partnerships.
For more information on Amedica or its silicon nitride material platform, please visit www.amedica.com.
Forward-Looking Statements
This press release contains statements that constitute forward-looking statements within the meaning of the Securities Act of 1933 and the Securities Exchange Act of 1934, as amended by the Private Securities Litigation Reform Act of 1995. Such statements are subject to risks and uncertainties that could cause actual results to differ materially from those contemplated within this press release. A discussion of those risks and uncertainties can be found in Amedica’s Risk Factors disclosure in its Annual Report on Form 10-K, filed with the Securities and Exchange Commission (SEC) on March 23, 2016, and in Amedica’s other filings with the SEC. Amedica disclaims any obligation to update any forward-looking statements.
Contacts:
Kevin Ontiveros
801-839-3502
[email protected]
Source: Amedica Corporation

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Rotation Medical's Bio-inductive rotator cuff repair looks promising early

ROTATION MEDICAL’S BIOINDUCTIVE IMPLANT: POSITIVE RESULTS (Orthopedics This Week)
website Rotation Medical
Rotation Medical Inc., a company focused on solutions for rotator cuff disease, has announced results of a retrospective study that should be exciting for those interested in tissue healing. According to the September 27, 2016 news release, the biopsy study, published online in Arthroscopy, “supports the biocompatibility of the company’s bioinductive implant and its ability to promote new connective tissue with the histological appearance of tendon.”
“This is a breakthrough study, as it is the first to show that the Rotation Medical bioinductive implant promotes the rapid growth of tendon-like tissue in humans,” said Dr. Steven P. Arnoczky, lead investigator of the study and director of the Laboratory for Comparative Orthopaedic Research at Michigan State University. “While clinical studies have demonstrated evidence of new tissue generation via imaging, the histologic character of this tissue could only be inferred. The unique opportunity to evaluate biopsies from implant recipients confirms the findings of the preclinical animal study, and demonstrates that the implant is biocompatible and promotes new connective tissue with the histological appearance of tendon over the surface of the native cuff tendon.”
Dr.Arnoczky told OTW, “In general, the ability to histologically examine the natural history of a biodegradable implant in a clinical setting in humans is an exciting and an extremely rare opportunity. Especially since none of the second-look arthroscopic procedures which provided the biopsies were related to any clinical issues with the implant.
“While the preclinical animal studies have unequivocally established the safety of this implant, as well as provide a detailed examination of its tissue induction and tissue conduction capabilities, the ability to confirm that the process of biological incorporation, tissue generation, and tissue maturation occurs in a similar manner and over a similar time period in humans is very significant.
“I wouldn’t say there were any surprises, as previous clinical assessments of the implant using magnetic resonance imaging (MRI) have provided substantial proof as to the tissue induction abilities of the implant. Rather, the histological analysis of biopsies from different individuals at different time periods representing a span of six months allowed us to more precisely confirm the results from our preclinical animal study.
“I believe the current study together with the data from preclinical and clinical studies provide compelling evidence as to the ability of the Rotation Medical Collagen Implant to induce the formation of host-derived, tendon-like tissue in a consistent and predictable manner.”

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