Knee Cartilage Defect Treatment Options
Articular cartilage is the white tissue lining the end of bones where these bones connect to form joints. Cartilage acts as cushioning material and helps in smooth gliding of bones during movement. An injury to the joint may damage this cartilage which cannot repair on its own. Cartilage can be damaged with increasing age, normal wear and tear, or trauma. Damaged cartilage cannot cushion the joints during movement and the joints may rub over each other causing pain and inflammation. Cartilage can also break off into the joint causing a sensation of locking or catching in the joint.
The treatment of knee cartilage defects depend on the size, location, and severity of the defect, as well as the individual’s age, activity level, and overall health.
Non-surgical treatments are often the first line treatment offered. This involves pain management with over-the-counter anti-inflammatory drugs like NSAIDs, pain relievers, and injections can reduce inflammation and treat pain. PRP has been effective in the treatment of cartilage disorders and may be an option for some patients. Rest, activity modification, and physical therapy. When conservative management fails to relieve symptoms, surgery may be recommended.
Cartilage restoration is a category of surgical procedures where specialized orthopaedic surgeons stimulate the growth of new cartilage that restores the normal function. Arthritis can be delayed or prevented through these procedures.
Several techniques are employed for cartilage restoration including microfracture, enhanced microfracture, osteochondral autograft and allograft transplantation, and autologous chondrocyte implantation (MACI). Most “true” cartilage restoration or joint preservation surgeries require staging. Staging refers to an initial diagnostic arthroscopy to measure the defect down to the millimeter, debride the defect, assess other areas of the joint (meniscus/ligaments) and potentially harvest a sample of healthy cartilage cells.
In this method numerous holes are created in the injured joint surface using a sharp tool. This procedure stimulates healing response by creating bleeding into the site of injury. Blood supply results in growth of new cartilage. However, this type of cartilage is called fibrocartilage and does not have the same microstructural properties of your normal hyaline/articular cartilage. Fibrocartilage sometimes is referred to as “scar” cartilage. Thus, this procedure has fallen out of favor in Dr. Patel’s practice.
Enhanced microfracture refers to techniques that augment standard microfracture techniques to induce the formation of more normal articular or hyaline cartilage.
A healthy bone and cartilage plug (graft) is taken from the bone that bears less weight and is transferred to the injured bone and cartilage location. This method is used for smaller cartilage defects; typically less than 1cm in size. This provides an effective way to treat certain cartilage injuries with a patient’s own cartilage.
A bone and cartilage plug (graft) is taken from a donor and transplanted to the site of the injury. These grafts are screened and processed for sterility and safety. The allograft technique is recommended if a larger part of cartilage (>1cm) is damaged. There is also less comorbidity as no cartilage plug is taken from the patient.
The newest generation of this technology is called Matrix induced Autologous Chondrocyte Implantation aka MACI. A small piece of healthy cartilage from a non-functional site of the knee is harvested using arthroscopic technique and is processed and grown in a laboratory. Cultured cartilage cells (patient’s own cells) form a larger cellular membrane, which is then implanted in the damaged part during the second open surgery. The membrane allows us to treat larger areas of damage without comorbidity to the patient.
At a Glance
Ronak M. Patel M.D.
- Double Board-Certified, Fellowship-Trained Orthopaedic Surgeon
- Past Team Physician to the Cavaliers (NBA), Browns (NFL) and Guardians (MLB)
- Published over 49 publications and 10 book chapters
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