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Cartilage Repair
Until very recently, there has been no way to reliably repair an injury to the cartilage in your knee. Now there is a new technique that offers patients new hope for an otherwise untreatable problem.
Cartilage is the very smooth, slippery white coating on the ends of your bones (think of the end of a chicken leg) that cushions the joint, and provides an extremely low friction surface. When that cartilage becomes damaged, it generally does not heal, and slowly continues to break down. This may ultimately result in wearing the cartilage all the way down to bone, resulting in arthritis in the knee.
Previous methods to treat this difficult problem have included a variety of techniques, all designed to fill in the defect in the cartilage with fibrocartilage, a type of scar tissue. Unfortunately, this type of tissue does not have any of the special properties of true cartilage, and typically wears down with time. Recently, there have been exciting new advances in techniques of cartilage repair and transplantation.
Autologous Chondrocyte Implantation (Carticel)
This is a technique where the bodies’ own cartilage cells are used to repair defects or divots in the cartilage surface of the knee.
For this procedure, a very small piece of normal healthy cartilage is taken from the patient’s knee as a biopsy (with an arthroscopy), and the cells are then grown in an outside laboratory to large quantities. The patient’s own cartilage cells, or chondrocytes, are then reimplanted back into the knee, into the cartilage defect on the end of the femur (thighbone). Like seeding an area of a lawn, the new cells grow, and fill in the hole in the cartilage.
Patients typically have to protect the knee, using crutches for six weeks, and participate in a fairly intensive physical therapy program.
The results of this procedure are extremely encouraging, with marked improvement in over 90 percent of knees treated. Large cartilage defects can be successfully treated. Plus, this type of repair appears to hold up well with time, with results now well over ten years. Our own experience with this technique has been similarly exciting.
Osteochondral Autograft Transplant (OATS procedure)
For smaller defects in the cartilage surface of the knee, it is now possible to directly repair this at one setting. This procedure involves grafting a piece of cartilage from another place in the knee that does not bear weight, and transplanting that cartilage directly into the defect in the weight-bearing portion of the knee. Small cylindrical plugs of bone and cartilage, about a quarter to half an inch in diameter, are harvested from one area, and used to fill the cartilage defect, not unlike hair plugs.
Again, patients typically have to protect the knee, using crutches for six weeks, and participate in a fairly intensive physical therapy program.
The results of this procedure show excellent cartilage repair in smaller defects, and also appear to stand the test of time.
This technique is useful for smaller defects, and has the added benefit of being done entirely arthroscopically, without an open incision.
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