October 24, 2018
Articular Cartilage is the white tissue lining the end of bones that acts as a cushioning material as well as a smooth gliding surface for the joint during motion. Cartilage injury can either be acute, such as a traumatic event, or chronic, such as normal wear and tear associated with osteoarthritis. Damaged cartilage has difficulty healing itself and cannot cushion the joints during movement. This in turn leads to increase friction within the joint, causing severe pain and inflammation.
Cartilage restoration involves a variety of procedures focusing on stimulating the growth of new cartilage that helps restore normal function. The progression of arthritis can be delayed or at times even prevented by way of these procedures.
Techniques include acute arthroscopic versus open reduction and internal fixation (ARIF/ORIF), microfracture, osteochondral autograft, allograft transplantation, and autologous chondrocyte implantation (MACI):
- ARIF/ORIF is performed in acute injury or fracture of a present osteochondritis dissecans lesion, resulting in a loose body present in the knee. The fragments can often be salvages and fixed back into position utilizing different arthroscopic or open techniques. If able to heal, this procedure maintains the native bone and cartilage.
- Microfracture is an arthroscopic technique that involves punching numerous holes into the bone surface where the cartilage is deficient, in the attempt to stimulate a healing response by way of the body’s own blood supply. A fibrocartilage layer fills in this area, thus covering the defect.
- Osteochondral Autograft Transplantation (OATS) is a technique where healthy bone and cartilage is obtained from a portion of the knee that bears less weight and transferred to the affected area. This is a very effective method for treating smaller defects.
- Osteochondral Allograft Transplantation is a similar procedure to OATS, but involves tissue obtained from a donor and transplanted into the affected area. This is the preferred technique for larger sized defects.
- Autologous Chondrocyte Implantation is a novel technique where small portions of the non-articulating cartilage surface are harvested and cultured in the lab. It is grown on a matrix patch which is then implanted into the area. This is a more advanced method of trying to restore the cartilage surface with the patient’s own cartilage cells.
These are typically outpatient procedures and can be supplemented with off-loading osteotomies when indicated. There is a period of protected weight bearing for approximately 4-6 weeks, after which the weight bearing status is advanced in a progressive fashion as guided by our physical therapy team. Return to activity without restriction is typically achieved between 4-6 months.
If you’re suffering from joint pain or inflammation, you can schedule an appointment here.