Articular cartilage is a complex avascular (no blood supply) tissue which is produced by cells called chondrocytes. It appears as a smooth, shiny, white tissue at the ends of the bones which come in contact with each other to form a joint. In addition to acting like a shock-absorber, It reduces the friction when the bones glide over each other and making movements smooth and enables the joint withstand weight.
Cartilage in our joints is subjected to the normal wear and tear and may sometimes get damaged because of injury causing pain and impaired function. When this happens, cartilage does not have the ability to heal or repair on its own. There are several biologic and surgical therapies available which can help to restore, repair, replace or reduce the pain associated with cartilage injury. the articular cartilage. These techniques can prolong the health of joints and prevent further damage which may eventually progress to arthritis.
Cartilage restoration techniques range from injectable biologics such as stem cells and PRP to surgical procedures. These types of procedure can serve to repair or restore areas of damaged cartilage biologic solutions. Many cartilage restoration procedures are done using an arthroscope. However, In some procedures, incisions may be required to gain access to the affected area which may require transplantation of new healthy cartilage.
Dr. James Kercher is a fellowship trained sports medicine surgeon specializing in minimally invasive techniques in sports medicine. His clinical focus is on cartilage restoration, patellofemoral surgery and the arthroscopic treatment of complex knee and shoulder injuries. He has served as team physician for the Chicago Bulls, Chicago White Sox and multiple semi-professional, university and high school sports teams. Read more.
In certain situations damaged cartilage can be trimmed and stabilized. This prevents the damaged tissue from breaking free which can cause swelling and pain. This “clean up” type procedure is called a chondroplasty. Microfracture can be used to produce repair tissue. Small holes in the underlying bone are created with a pick or drill allowing cells to migrate to the area or injury. This is a reparative process and can be successful in eliminating symptoms. Studies suggest that repaired cartilage is less resistant to wear than normal articular (hyaline) cartilage. Certain techniques can be used to enhance the regenerate tissue to produce a more natural cartilage.
Allograft cartilage which contains the extracellular matrix and key components such collagen, proteoglycans and growth factors can be used to augment areas of microfracture. When added, these components serve as a scaffold to improve healing within a properly prepared cartilage defect.
ACI is a technique is performed in two stages. The first stage is performed during arthroscopic evaluation of the joint to determine the characteristics of the injured area. If an appropriate lesion is identified a biopsy specimen of your own articular cartilage is harvested. The biopsy is next sent to a lab where the cells are amplified to over 10 million cells. The prepared cells are then re-implanted into the cartilage defect under a biologic patch. The cells then gradually form hyaline-like cartilage to restore areas of cartilage loss.
Matrix-induced ACI (MACI) is a cutting edge variation of the original ACI procedure. Like ACI, this is a 2-stage procedure but cells are seeded into a three dimensional scaffold to fill the prepared cartilage defect. Once the implant has been prepared, it can be glued into the chondral defect through a small incision. This improves nourishment, consistency and placement of the cells into the defect and provides a scaffold for the cells to grow upon while regenerating the cartilage in the defect.
DeNovo® tissue graft contains particulated natural articular cartilage living cells harvested from juvenile donors (aged below 13 years). Transplantation of DeNovo® is a simple single-step procedure where the graft is fixed into the prepared injured area using fibrin glue.
This technique involves the transfer of good cartilage to an area of injury. A small plug of the patient’s own cartilage along with attached bone is obtained from an area of the knee. This bone and cartilage ‘plug” serves as a local graft which is transferred to the prepared defect. This technique is limited to small areas of cartilage injury because there is a limit to the amount of tissue available in your own knee to move without causing a problem.
Osteochondral allograft is a cartilage grafting techniques similar to the OATs procedure but wiouth size constraints. This procedure is good for larger defects. Living healthy cartilage taken from a donor can be used to replace damaged cartilage. This procedure is indicated in patients with larger articular cartilage defects and is done through open surgical procedure. The main disadvantage of this method is limited availability of donor grafts.
If your meniscus has been severely damaged or previously removed, the articular cartilage protecting your knee may be subject to accelerated wear leading to arthritis. The goal of meniscal transplant surgery is to replace the meniscus before the cartilage becomes damaged. The donated meniscal cartilage protects and stabilizes the knee joint. The transplant can delay the development of arthritis and improve the function of your joint.
