Cartilage Repair Techniques
This website focuses on articular cartilage repair treatment, which means the restoration of damaged hyaline cartilage in the joints.
Cartilage repair and regeneration is a treatment for joints that have damaged cartilage but are otherwise healthy.
The treatment is recommended for patients with cartilage damage or deterioration caused by:
- Injury or trauma, including sports injuries
- Repetitive use of the joint
- Congenital abnormalities – abnormalities a person is born with – that affect a normal joint structure
- Hormonal disorders that affect bone and joint development, such as osteochondritis dissecans (OCD)
There are several types of procedures for cartilage repair and regeneration that are designed to heal the cartilage by filling the cartilage defect (pothole) with repair tissue.
The choice of procedure depends on the size and location of the defect. Larger defects are typically treated with autologous chondrocyte transplantation or osteochondral allograft transplantation, both of which require open incisions. Smaller defects in specific locations can be treated with marrow-stimulating techniques, autologous chondrocyte implantation (ACI), or osteochondral autograft transfer.
The aim of this article is to provide comprehensive information about chondral/osteochondral lesions and possible ways of cartilage repair. This section is recommended for anyone interested in cartilage problems, and for patients suffering from chondral/osteochondral lesions.
What is cartilage repair?
Osteochondral/chondral repair means a restoration of the cartilage (articular) surface of a joint that has been affected by an osteochondral/chondral defect. The affected joint usually swells up following injury, and it may take weeks or even months before the swelling goes down. This swelling can recur.
Drugs such as aspirin, ibuprofen, and naproxen, known as non-steroidal anti-inflammatory drugs (NSAIDs), and other conservative treatments usually have the only limited effect on the pain and do not treat the underlying problem.
If there is a severe fluid build-up and a loose body in the joint, removal and treatment via arthroscopy may be necessary. Arthroscopy is also useful for assessing the cartilage lesion, as knowing the extent of the affected area is crucial for deciding the best treatment. The methods typically used for cartilage repair are, depending mostly on the size of the lesion: microfracture, mosaicplasty, cartilage cell implantation (autologous chondrocyte implantation) or large allograft implantation.
The decision over surgical management of cartilage defects depends on the size and location of the defect, and whether it is self-contained or spread out.
It also depends on:
- Whether or not the joint has been operated before
- The patient’s age
- The patient’s physical fitness and activity
- Whether the patient wants to undergo surgery
- The presence of other conditions and diseases
- The presence of any associated injuries
Treatment of any other joint problems, such as the reconstruction of ligaments, corrective axial procedures (osteotomy), meniscus removal (meniscectomy), or suture/replacement of a torn meniscus, must be included in the operation and postoperative rehabilitation. Otherwise, early wear of the resurfaced area or even worse degeneration may develop.
Treatments that provide hyaline or hyaline-like cartilage coverage for cartilage defects are generally better than those that use a connective tissue or fibrocartilage surfaces.
What are the advantages and disadvantages of Cartilage Repair Techniques?
What are the advantages of Cartilage Repair Techniques?
Osteochondral/chondral lesions have a very poor ability to regenerate. Without surgery, the condition gets worse, and sooner or later it will advance to a level where total joint replacement becomes necessary. Patients need to have a surgery to improve their quality of life and to be able to return to their daily activities.
What are the disadvantages of Cartilage Repair Techniques?
There are no disadvantages of osteochondral/chondral repair. Surgery slows down an otherwise inevitable process. However, as with all surgical procedures, there is a risk of complications such as deep vein thrombosis, bleeding into the joint and painful scar tissue restricting joint movement. These would be discussed with the doctor at the time of surgery.
Frequently Asked Questions (FAQs)
What are my options for treatment?
There are different surgical and non-surgical options, depending on the sex and age of the patient, and the nature of the injury. The decision of which technique is optimal should be made on an individual basis in collaboration with a surgeon specializing in articular cartilage repair that has broad experience with the entire spectrum of cartilage repair techniques.
What are the chances of an operation solving cartilage problems in the long-term?
Cartilage repair procedures are still relatively new field. There is little long-term data both on the natural history of untreated cartilage lesions or studies that can predict surgical results years and years into the future. That being said, encouraging mid-term results are hoped to carry on into the long-term.
Will they implant any foreign material into my joint that will cause an allergic reaction or has to be removed later?
Normally the answer is no unless the patient has another procedure, such as anterior cruciate ligament reconstruction or an osteotomy. For which, in rare cases, the fixation device or plate may have to be removed at a later time if it begins to cause irritation.
Could the surgery be avoided or delayed?
Chondral/osteochondral lesions are not able to ‘self-repair’. The condition could potentially get worse over time and may cause more pain and a variety of other problems. The patient may have to give up sporting activities, and conservative treatment such as non-steroidal anti-inflammatory drugs (NSAIDs) can only delay this progress.
How long will I be in the hospital; how long before I can start weight bearing exercises; how long is the rehabilitation period; and when
can I return to work/sport/daily activities? Or, most importantly: When can I drive?
The answer is that it depends on the type of cartilage repair technique used and whether or not another procedure, such as the reconstruction of the anterior cruciate ligament or an osteotomy, was performed. It also depends on the daily activities of the patient. Therefore, the duration of treatment, hospital stay, and expected rehab are usually individualized based on the patient’s exact pathology.
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