The common techniques employed for cartilage restoration include cartilage replacement and cartilage repair & transplantation.
What is Cartilage Replacement?
Cartilage replacement is a surgical procedure performed to replace the worn-out cartilage with new cartilage. It is usually performed to treat patients with small areas of cartilage damage usually caused by sports or traumatic injuries. It is not indicated for those patients who have advanced arthritis of the knee. Articular or hyaline cartilage is the tissue that covers bone surface of the knee which helps in smooth interaction between the two bones in the knee joint. It has less capacity to repair by itself because there is no direct blood supply to cartilage.
Cartilage Replacement Procedure
Cartilage replacement helps relieve pain, restore normal function, and can delay or prevent the onset of arthritis. The goal of cartilage replacement procedures is to stimulate growth of new hyaline cartilage. Various arthroscopic procedures involved in cartilage replacement include:
- Microfracture: Microfracture involves creating numerous tiny holes in injured joint surface using a special tool, called ‘awl’. The holes are made in the bone under the cartilage, called as subchondral bone. This creates a new blood supply to the cartilage which stimulates the growth of new cartilage.
- Drilling: This procedure is like microfracture where multiple holes are created in the injured joint area using a surgical drill or wires.
- Abrasion Arthroplasty: This procedure is like drilling but involves use of high speed burs to remove the damaged cartilage.
- Autologous Chondrocyte Implantation (ACI): This is a two-step procedure, where healthy cartilage cells are removed from the non-weight-bearing joint, grown in the laboratory and then implanted in the cartilage defect during the second procedure. During this procedure, a patch is harvested from the periosteum, a layer of thick tissue that covers the bone and is sewn over the defective area using fibrin glue. The new cartilage cells are then injected under the periosteum into the cartilage defect to allow the growth of new cartilage cells.
- Osteochondral Autograft Transplantation: In this procedure, plugs of cartilage are taken from the non-weight-bearing areas of knee, from the same individual and transferred to the damaged areas of the joint. This method is used to treat smaller cartilage defects since the graft which is taken from the same individual will be limited.
Following cartilage replacement, Dr Maor will recommend physical therapy to help restore mobility to the affected joint.
- Osteochondral Allograft Transplantation: In this procedure, healthy cartilage tissue or a graft is taken from a donor from the bone bank and transplanted to the area of cartilage defect.
What is Cartilage Transplantation?
The articular surfaces of the body’s joints are lined by hyaline cartilage, a smooth tissue that serves as a shock absorber and allows easy movement of the bones within the joint. Normal wear-and-tear or injury can damage and cause defects in the cartilage, resulting in irregular articular surfaces that interfere with movement, causing pain, swelling and disability. Cartilage cell transplantation is a technique of transplanting healthy cartilage cells to replace damaged cartilage cells. These procedures are recommended for young individuals with a single articular defect. It is usually performed on the knee joint but may also be used to treat the shoulder and ankle joints.