What is Cartilage Repair and Restoration?
A joint is composed of two bones meeting together. The ends of each bone are covered with articular cartilage which is a smooth white covering that allows the bones to glide smoothly with one another. The knee joint is most commonly repaired but the shoulder, elbow and ankle can be done as well. The purpose of a cartilage repair is to fix damage to cartilage that happens from an acute injury. Cartilage restoration is a different type of surgical correction where new cartilage is placed in where cartilage has been lost or damaged over a length of time. These surgical procedures are tedious surgeries and are usually most successful when performed in younger patients. Older adults with multiple areas of degenerative cartilage disease are usually less likely to benefit from cartilage restoration.
Mechanism of Injury
Cartilage can be damaged in combination with a ligamentous injury, like when tearing an anterior cruciate ligament due to the pivoting that occurs during the injury. Cartilage can be damaged as a result of dislocations of the patella or kneecap, and in other joints. Other people are just born with bad cartilage from genetics or develop cartilage damage from inflammatory diseases (Rheumatoid arthritis, Lupus, etc). Normal wear and tear can happen as well which causes damage to cartilage, like rubber wearing out on tires with more mileage. .
Diagnosis and Symptoms
Typically, people will complain of pain to a specific area in the knee where the cartilage damage has occurred. There may be swelling, fluid in the knee (effusion), cracking and popping. A physical exam by a provider is important to determine the overall function of the knee. X-rays should always be performed to rule out chronic or long-standing arthritis that could be the reason for the joint pain. Advanced imaging (CT, MRI) may be performed in order to assess for the possible surgical corrections.
Treatment for a Cartilage Injury
There exist many different treatment options for a cartilage injury depending on the acuteness (how long since the injury), the location in the knee, and the size of the cartilage damage. Surgical repair can be done arthroscopically with debridement and microfracture. Microfracture involves poking small holes in the exposed bone to cause bleeding which fills in the defect with fibrocartilage. Cartilage repairs are often done by open surgery to adequately repair the damage and place screws to fix the damage. Cartilage restoration involves many different surgical techniques to address the cartilage damage that has occurred over a long period of time, cannot be repaired, or if the damaged cartilage area is too big for a simple repair. These may include OATS (autograft and allograft cartilage transplants), MACI (cartilage transplants of one’s own cells) and using other types of juvenile cartilage cells, engineered cells or cells used from someone else (a cadaver). OATS involves transferring a small piece of bone and cartilage from one aspect of the knee to another. This can also be done using live cells from another person, called allograft. MACI is a technique in which one’s own cells are grown in a lab, placed on a membrane and implanted into the defect. These procedures are technically challenging, still in evolution in medicine and require a lengthy recovery. Overall, these surgical procedures have been successful with the goal to decrease one’s pain and prolong the development of arthritis.
For more information, please consider the following link that was produced by the AAOS.
https://orthoinfo.aaos.org/en/treatment/articular-cartilage-restoration