Articular cartilage is the unseen enabler of easy movement, a protector of joints that makes smooth motion possible. You probably don’t appreciate it enough when it’s working well but you may become very aware of it when it’s damaged. At that point, you may even find yourself discussing a cartilage transplant with your orthopaedic surgeon.
What is articular cartilage?
Articular cartilage is found in many joints, including your elbows, wrists, neck, hips and knees. It’s a smooth, white tissue that covers the ends of your bones where they meet other bones to form joints. This articular cartilage allows the bones to glide over one another smoothly, making it easier for you to move. It’s a little like wrapping the ends of your bones in lino.
What damages articular cartilage?
Articular cartilage is strong and long-lasting but it may be damaged by:
- Traumatic injuries such as a sports collision or fall, including overtwisting the joint while weight bearing (e.g. twisting your knee while your foot is planted)
- Repetitive strain through many smaller impacts
- Wear and tear, especially as you get older when the joint has been in use for decades
- Poor joint alignment due to a previous injury or an abnormality present from birth.
Articular cartilage in the knee
The most common site for an articular cartilage injury is the knee, perhaps because this is such a hard-working joint used in running and pivoting.
If you’ve damaged the articular cartilage in your knee, you may notice that it no longer moves smoothly. You may experience:
● Discomfort when you bend or move the joint – people describe crackling, grating, popping or catching noises and sensations
● Limited movement – you may not be able to fully extend or bend the joint
● Stiffness.
Treatment options: Is transplantation an option?
Unfortunately, once it’s damaged, articular cartilage does not repair itself well. As a result, orthopaedic surgeons have developed a number of surgical approaches.
The right approach for you depends on the:
- Extent of your articular cartilage damage
- Demands that your lifestyle or chosen sport place on your knee.
Wherever possible, we use arthroscopic techniques (keyhole surgery). Options include:
- Repairing or regenerating cartilage
- Transplanting cartilage.
Cartilage transplantation: How does it work?
A cartilage transplant may come from a different area of your own body (an autograft) or from a donor (allograft).
Osteochondral autograft transplantation (OATS)
An OATS procedure involves transplanting healthy cartilage and the bone that sits underneath it (subchondral bone) from an area of the joint that does not bear weight. This graft is then used to plug the damaged cartilage to maintain a healthy joint surface.
For lesions below 20 mm, this can usually be done arthroscopically. Larger lesions may need open knee surgery.
Osteochondral allograft transplantation
If you have a larger area of damaged cartilage, we may not be able to borrow tissue from elsewhere in your own joint without causing you other problems.
In such cases, we then consider an allograft – a cartilage transplant using donor material. The graft is sterilised and shaped to be the correct size and curvature for your needs. Once ready, the graft is transplanted to your joint during open surgery.
When the damaged area of cartilage is too large for autograft transplantation, the defect can be filled by donor tissue or a cadaveric graft. The graft is sterilised and matched to the donor, to ensure it is the correct size and curvature for the native joint. It is shaped to fill the defect and transferred to the joint via an open technique.
How can I help?
I’m a highly trained and experienced orthopaedic surgeon with subspecialty training in knee and sports surgery. I’ve performed many cartilage transplants, helping elite athletes and weekend warriors to get back in the game.
Please make an appointment today.
Disclaimer
All information is general and is not intended to be a substitute for professional medical advice. Any surgical or invasive procedure carries risks. Dr Ross Radic can consult with you to determine if a particular treatment or procedure is right for you. A second opinion may help you decide on your options.
References
- American Academy of Orthopaedic Surgeons, Articular cartilage restoration, https://orthoinfo.aaos.org/en/treatment/articular-cartilage-restoration/#, [Accessed 30 October 2024]
- Yale Medicine, Cartilage injury and restoration, https://www.yalemedicine.org/conditions/cartilage-injury-and-repair, [Accessed 30 October 2024]
