Treatment of Articular Cartilage Loss
Thousands of patients each year sustain articular (joint) cartilage injuries. These are not meniscal tears, but damage to the smooth cartilage that covers the ends of a bone and actually forms the joint itself. Although smaller lesions do not require any additional treatment besides removal of the loose pieces of cartilage, many of these injuries may ultimately progress to larger lesions with resultant pain, stiffness, and joint dysfunction. The loss of articular cartilage is often the first stage in the development of osteoarthritis. Young, active patients should be able to access effective treatment in the early stages of this process to hopefully prevent the loss of function and increasing pain that accompanies osteoarthritis.
There are many new biologic treatments for articular cartilage injuries with promising clinical results. Some have short-term follow up studies and have only been used in a limited number of patients. Other treatments have established treatment protocols and reliable results in many patients. Given the complexity of these injuries, it is important to have a variety of treatment options available. Many patients may also have alignment issues, meniscal problems, bone loss, and other factors that need to be addressed during joint preservation procedures.
Northwest Orthopaedic Specialists has been at the forefront of joint preservation procedures for many years. We were chosen as a site for a landmark FDA articular cartilage study and have continued to perform this as well as other procedures for joint preservation and reconstruction. Described below are some of the treatment options.
Autologous Chondrocyte Implantation
Every joint has a smooth surface formed by articular cartilage. Living, articular cartilage cells produce this smooth and resilient surface, which is the foundation of a healthy joint. Your own cartilage cells may be cultured (grown in a laboratory) and then reimplanted into a cartilage defect so that the cells may reproduce this smooth surface once again.
This is a two-stage procedure beginning with a biopsy that is performed arthroscopically (small incisions and a small telescope inserted into the knee). Once these cells are mature, the reimplantation of this tissue is performed through an incision over the front part of the knee. The surgery usually takes about an hour and is often done as an outpatient procedure. Depending upon the location of the cartilage defect, rehabilitation and physical therapy begins immediately and may continue for 6 to 12 weeks. There will also be an extensive home exercise program.
Although the recovery may be prolonged, the procedure has an excellent record in joint preservation with a very durable result. The ideal patient for this type of procedure is a young, active person who has a cartilage defect and is willing to commit to the rehabilitation program. Once arthritis has developed, ACI is no longer an effective treatment and other procedures may be a better choice.
Autologous chondrocyte implantation (ACI) has been available in the United States since 1997, and Northwest Orthopaedic Specialists was selected as a site to perform the landmark FDA study on this procedure (STAR Study). We have continued to perform ACI since that time and have extensive experience with this procedure.
Living articular cartilage may also be transplanted from other patients. A cadaveric graft may be obtained and fashioned to fit into a cartilage defect. Cartilage does not provoke an immune response and tissue matching is not required. The underlying bone on the back surface of the graft heals to the patient’s own bone, resulting in a stable, smooth surface. This is a single-stage procedure (single operation) that is performed through an incision in the front of the knee.
The rehabilitation from this procedure is reasonably short, with full weight bearing allowed at approximately 2 weeks. Although not applicable to all cartilage problems or defects, it has been very successful in joint preservation. It is also useful for patients who may have some degree of bone loss in association with the cartilage defect.
Particulated Juvenile Cartilage Allograft
Juvenile articular cartilage has growth potential, which allows this implanted material to reproduce articular cartilage when implanted into cartilage defects. This cartilage graft is an allograft tissue, obtained from human donors and does not require tissue matching to avoid rejection. This is a single-stage procedure that can be done for a variety of articular cartilage defects. It is performed through an anterior knee incision and may be combined with other procedures. The rehabilitation program is determined by the location and size of the articular cartilage defect.
To find out if ACL reconstruction is right for you, schedule an appointment with one of our joint preservation surgeons by calling 888-660-2663 or complete the appointment request box.