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Cartilage Restoration

 

Articular cartilage is a tissue that covers the ends of bones where bones articulate as joints.  In a healthy joint, cartilage is shiny, white and smooth.  Healthy cartilage allows for smooth movement and less friction between the bones.  Articular cartilage can be damaged with chronic “wear-and-tear” or with an acute traumatic injury.  Because articular cartilage cannot heal on its own, surgical techniques have been developed to relieve pain and potentially delay the onset of severe joint arthritis.

 

There are four different surgical techniques to treat cartilage damage or chondral lesions.  They are Microfracture, Osteoarticular Transfer System (OATS), Osteochondral Allograft and Autologous Chondrocyte Implantation (ACI).  The type of surgery will depend on the extent of damage as well as patient age.

 

Microfracture surgery is a procedure in which an instrument shaped like an ice pick is used on the joint surface to expose underlying tissue and fluid (bone marrow).  Exposing bone marrow to the injured area will stimulate growth and production of fibrous tissue to fill in the lesion.  This procedure is ideal for younger patients with smaller lesions.  Recovery from this procedure involves non-weight bearing with crutches for a period of 1-2 months, withholding from sporting activities for up to one year and full recovery expected within 1.5 years.

 

OATS is a procedure in which healthy articular cartilage is harvested from a non-weight bearing area on the same bone that is damaged.  The healthy tissue is placed into the injured area and secured with a net-like structure and sutures.  This procedure is done for the most part arthroscopically (thin camera inserted into the knee through 2 or 3 incisions each ¼ inch long) with one additional small incision.  It is indicated if the chondral lesion is relatively small (1-2cm in diameter).  Recovery is relatively quick with this procedure consisting of a period of non-weight bearing (4-6 weeks), pain relief is expected within 2-4 months and return to sporting activities in 3-6 months.

 

Osteochondral Allograft is a procedure where a graft is harvested from a cadaver with healthy, living cartilage cells.  The graft is matched to the exact size and shape of the specific damaged area.  The donor tissue is withheld for a period of time (generally 3 weeks) for testing to ensure the tissue is healthy and free of diseases such as Hepatitis, HIV and bacteria.  This surgery has a much larger incision and is therefore considered and open procedure.  It is indicated for larger lesions and relatively older patients.  The recovery is considerably longer with a period of non-weight bearing for 3-6 months, and return to activity at one year.

 

ACI is an alternative procedure to Osteochondral Allograft.  Unlike Osteochondral Allograft, the ACI procedure harvests your own tissue instead of utilizing cadaver tissue.  Additionally, ACI is a two-step procedure requiring two separate surgeries.  The first surgery is an arthroscopic procedure to procure tissues from the healthy area of the knee.  The tissues are then sent to the Genzyme lab (insert link here!) for cell expansion.  Once the cells have properly developed, a second procedure is performed to implant the cells.  This procedure is only indicated for a large, full-thickness lesion on the femur and if the patient is young and willing to be compliant for a long recovery (up to 2 months non-weight bearing, 12 months for pain relief and up to 18 months for return to activity).