Cartilage Repair

A cartilage repair procedure can help restore damaged cartilage in joints such as the knee, ankle, and shoulder. Damaged cartilage, whether from injury or arthritis, can lead to pain and reduced mobility. The procedure aims to alleviate pain and restore joint function by addressing cartilage damage and promoting regeneration, potentially delaying or eliminating the necessity for joint replacement.

What You Need To Know About Cartilage Repair

• What Is a Cartilage Repair?

• Cartilage Repair Options

• Why Is a Cartilage Repair Performed?

• How To Prepare for a Cartilage Repair

• What Happens During a Cartilage Repair?

• Are There Risks Associated With a Cartilage Repair?

• Post Cartilage Repair & Recovery

Cartilage repair is a procedure or series of procedures used to treat damaged or injured cartilage in the body. There are several kinds of cartilage restoration procedures, including microfracture, osteochondral autograft transplantation (OATS or Mosaicplasty), osteochondral allograft transplantation, and autologous chondrocyte implantation (ACI/Carticel).

The choice of procedure depends on the size and location of the damaged cartilage, with more significant defects often treated using ACI or osteochondral allograft transplantation, which requires open incisions. However, more minor issues may be addressed with less invasive techniques like microfracture or osteochondral autograft transfer, involving smaller incisions.

Cartilage repair procedures can help rebuild cartilage after damage caused by conditions such as arthritis or sports-related injuries—successful cartilage repair results in the formation of robust cartilage-like tissue around joints, enhancing stability and function.

We offer several cartilage repair options depending on your condition, including:

• Autologous Chondrocyte Implantation (ACI) with biologic patch is a procedure that helps regenerate the patient's cartilage cells. In a two-stage process, cells are harvested, cultured in a laboratory, and applied to the damaged area. This joint preservation treatment, commonly performed on the knee, stimulates the growth of new cartilage and repairs the damaged area over several weeks.

  
  

• Osteoarticular Transfer System (OATS), or mosaicplasty, involves transplanting healthy cartilage from non-weight-bearing areas to damaged regions within the same joint. It's particularly effective for small areas of damaged cartilage and eliminates allergy or transplant rejection risks.

  
  

• Microfracture is a cartilage repair procedure that involves creating small perforations in damaged cartilage without penetrating the underlying bone. These perforations prompt the release of reparative cells from the bone marrow, leading to the development of new cartilage-like tissue over time.

• Drilling is a cartilage repair technique that uses small holes to enhance blood flow and encourage new tissue growth. These holes facilitate the arrival of blood vessels and bone marrow cells at the damaged site to promote healing.

• Abrasion arthroplasty is a procedure that involves smoothing or scraping damaged cartilage to promote the growth of new tissue, contributing to cartilage repair.

• Osteochondral allograft transplantation replaces damaged cartilage with grafts from a cadaver.

• Tissue-engineered constructs use scaffolds and cells to regenerate cartilage.

Cartilage repair is performed to restore optimal function within a joint and alleviate pain, swelling, and locking. Cartilage does not repair well naturally, so intervention is necessary to promote healing and prevent progressive joint deterioration. Once bone-on-bone arthritis sets in, cartilage repair becomes less feasible, making joint replacement or osteotomy more suitable options.

This procedure is typically considered for younger, active individuals where joint replacement is not an immediate option due to its longer recovery time. Individuals with damaged cartilage resulting from overuse, injuries, birth defects, or hormonal disorders may benefit from cartilage repair, excluding cases of osteoarthritis. The key advantages of cartilage repair include an increased range of motion in the knee, reduced pain, and improved joint health.

Before undergoing cartilage repair, it's crucial to adhere to the following guidelines:

• Discuss with your physician any current medications you are taking. Your doctor may instruct you to discontinue certain medications before the procedure to minimize potential complications. However, certain medications, such as blood thinners, may be necessary to mitigate bleeding risks.

• Stop smoking before the procedure to improve healing and facilitate faster recovery.

• Refrain from eating or drinking before the surgery according to your physician's instructions to prepare your body for the procedure.

Depending on your specific condition or injury, there are several different kinds of cartilage repair procedures your physician may recommend. Before any procedure, patients may need to adjust medications, quit smoking, and follow fasting instructions, depending on the type of anesthesia. It's essential to discuss specific requirements with the doctor based on the severity of the condition and the chosen surgical approach. Your physician may recommend one of the following procedures to repair your cartilage:

• Microfracture: Small holes are drilled into the bone and bone marrow beneath damaged cartilage. This stimulates the bone to repair itself and promotes the growth of new cartilage cells.

• Osteochondral Autograft Transplantation/Mosaicplasty: A small plug of healthy cartilage and underlying bone is removed from a non-weight-bearing part of the joint. The plug is then transplanted into the injured site, where a small hole has been drilled.

• Osteochondral Allograft Transplantation: Similar to autograft, but uses tissue from a cadaver. Suitable for significant cartilage injuries, though the transplanted cartilage may not be as durable as the patient's own.

• Autologous Chondrocyte Implantation (ACI): Healthy cartilage is removed, and chondrocytes are harvested and grown in a lab. After the surgical procedure, the cultured cells are implanted into the damaged cartilage site.

• Autologous Chondrocyte (ACT): Healthy cartilage is grown in a lab and surgically implanted into the knee after a few weeks.

• Cell-based Cartilage Resurfacing: An experimental procedure where healthy cartilage is grown in a lab and glued to the existing cartilage, eventually integrating together in a few months.

• Meniscus Transplant: A new meniscus from a cadaver donor is implanted into the knee, typically performed with a small incision and stitching the donor meniscus in place.

Cartilage repair is generally a low-risk procedure; however, certain risks and complications may arise, including:

• Infection: In rare cases, infection may occur, especially if the surgical site is not properly closed.

• Bleeding: Bleeding during cartilage repair surgery may result from damage to nerves and surrounding tissues.

• Complications due to Anesthesia: Anesthesia-related complications, though uncommon, can occur. Discussing the patient's medical history and overall health with the medical team helps lower these risks.

• Blood Clot: Surgery may lead to the formation of blood clots as tissues, debris, and fat flow into the blood during the operation. Proper medical attention is crucial to prevent and manage blood clot complications.

• Pain: Post-surgery, individuals may experience pain, which typically subsides as the wound heals.

Patients may spend 1-3 days in the hospital following a cartilage repair procedure and will need to use crutches for approximately eight weeks. The timeline for resuming specific activities varies, with stationary biking recommended at 4-6 weeks, swimming and elliptical training at 8-12 weeks, and light jogging achievable after a year. Sports, like basketball and longer-distance running, are typically allowed after 18 months. Most patients can engage in some physical activity after six to eight weeks, but full recovery may extend from four to eight months.

Physical therapy plays a crucial role in recovery to help restore strength and range of motion in the operated area. Some patients may wear a knee brace during recovery. For athletes, returning to their usual activities may take up to six months. Recovery time varies, with less invasive procedures like chondroplasty taking around six weeks for full recovery. However, more extensive cartilage restoration procedures like OATS, OCA, and MACI typically require 6 to 9 months for complete recovery. Consult your physician to discuss wearing crutches and a physical therapy routine for optimal recovery.