Cartilage repair or transplantation: who is a candidate?
Cartilage repair or transplantation is a treatment used for otherwise healthy joints, when the damage has not progressed to osteoarthritis. It is often used for patients with damage due to:
- Injury or trauma, including sports injuries
- Repetitive use
- Osteochondritis dissecans and joint developmental abnormalities
- Congenital abnormalities.
Knee imaging showing an osteochondral defect
Cartilage repair or transplantation: What treatments are available?
I perform most cartilage repair procedures arthroscopically. During arthroscopy, the joint is entered via two small incisions, approximately 1-2cm in length. The smaller cuts allow for a more rapid recovery, with less post-operative pain than traditional surgery. When treating large areas of damage, an open technique may be required.
Chondroplasty
Chondroplasty is performed arthroscopically, and describes smoothing irregular areas of cartilage or removing large flap tears which are causing mechanical obstruction. This is the simplest cartilage repair technique but does not aid regeneration of the cartilage surfaces.
Microfracture
This procedure is performed arthroscopically. The goal of microfracture is to stimulate the growth of fibrocartilage in the defect, by creating a new blood supply to the area. During microfracture a sharp awl is used to make multiple holes in the joint surface, allowing bone marrow cells to stimulate fibrocartilage covering of the area.
Arthroscopic view in microfracture surgery
Autologous chondrocyte implantation
Autologous chondrocyte implantation (ACI) is a two-stage procedure. During the first stage, a small biopsy of cartilage is taken from a non-weightbearing area of the bone. It is then sent to a laboratory where the cells are cultured and increase in number over a 4-6 week period.
At the second-stage surgery, the cultured cartilage is implanted into the defect by open surgery.
Diagram demonstrating the autologous chondrocyte implantation (ACI) procedure
Osteochondral autograft transplantation (OATS)
OATS procedure involves transferring healthy cartilage and subchondral bone from an area of the joint that does not bear weight to the damaged area. It is ideal for lesions up to 20mm in size. The graft is taken as a ‘plug’ of cartilage with underlying bone, thereby maintaining the health of the joint surface. I typically perform this procedure arthroscopically, although for some larger lesions an open approach may be required.
Osteochondral allograft transplantation
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.
If you are considering having cartilage repair and transplantation for your knee, please make an appointment to discuss your treatment options.
