Cartilage Repair

Articular Cartilage is the white tissue lining the end of bones where these bones connect to form joints. Cartilage acts as cushioning material and helps in smooth gliding of bones during movement. An injury to the joint may damage this cartilage which cannot repair on its own. Cartilage can be damaged with increasing age, normal wear and tear, or trauma. Damaged cartilage cannot cushion the joints during movement and the joints may rub over each other causing severe pain and inflammation.

Cartilage restoration is a surgical procedure where orthopaedic surgeons stimulate the growth of new cartilage that restores the normal function. Arthritis condition can be delayed or prevented through this procedure.

Several techniques are employed for cartilage restoration including dietary supplements, biologics (PRP & Mesenchymal Stem Cells), micro fracture osteochondral autograft, and allograft transplantation.

Dietary supplements: Dietary supplements such as glucosamine and chondroitin are the non-surgical treatment options for cartilage restoration. Chrondroitin sulphate and glucosamine are naturally occurring substances in the body that prevent degradation of cartilage and promote formation of new cartilage. Chrondroitin sulphate and glucosamine obtained from animal sources are available as over the counter products and are recommended for cartilage restoration. Results of this treatment vary from patient to patient, but the risk of side effects is very low. While these supplements can be costly, they are typically less expensive if purchased in bulk quantities. A reasonable approach is to try them for one month and determine for yourself whether they are providing you with symptomatic improvement. Apart from these various other nutritional supplements are also recommended such as calcium with magnesium and vitamin D as a combination, S-Adenosyl-Methionine and Methylsulfonylmethane.

Biologics: The utilization of biologics to slow the degradation of cartilage, improve symptoms, and restore function is growing in popularity. Many feel that biologics may be the future of orthopedics. While much still remains uncertain, research in PRP and Mesenchymal Stem Cells has shown promising results and risk benefit profile that clearly favors benefit over risk.

PRP- Platelet Rich Plasma

PRP is obtained by taking a person’s venous blood and spinning it down in a centrifuge to concentrate the patient’s own growth factors. This concentrate can be injected into the joint. It has been shown to work better than HA (synvisc, euflexxa, etc.) injections for symptomatic improvement of osteoarthritis.

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Stem Cell Therapy

Mesenchymal Stem Cells are cells that are typically harvested from the iliac crest of a patient’s pelvis as a bone marrow concentrate (BMAC). This aspirate is similarly spun down to concentrate the mesenchymal stem cells which are then injected into the joint where they have the potential to turn into cartilage cells and signal the cartilage and bone cells within the joint in an effort to stimulate a healthier environment. Both of these procedures can be routinely performed in the office under local anesthetic.

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Microfracture

This arthroscopic, minimally invasive procedure, utilizes a small sharp tool to created numerous small holes in the injured joint surface. Stem cells leach out through these holes and, under the appropriate post-operative rehab protocol, a layer of fibrocartilage is formed over the area of injury. This procedure stimulates healing response by creating new blood supply. Blood supply results in growth of new cartilage. It is best for small cartilage lesions in active people or larger cartilage lesions in less active people.

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Osteochondral Autograft Transplantation

Healthy cartilage tissue (graft) is taken from the bone that bears less weight and is transferred to the injured joint place. This method is used for smaller cartilage defects. Its benefit is that it replaces potholes of injured cartilage with healthy cartilage obtained from the same patient. The size of the lesion (pothole) that can be treated is limited by the amount of healthy cartilage that one can donate without cause problems or donor site morbidity elsewhere.

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Osteochondral Allograft Transplantation

Similar to the Osteochondral Autograft technique, however in this case the cartilage tissue (graft) is taken from a donor and transplanted to the site of the injury. Because a larger donor (cadaver) graft can be used, there is no donor site morbidity. This “allograft” technique is recommended if larger part of cartilage is damaged. These are live cells obtained from recently deceased and generous donors. There is a time period in which these cells need to be implanted, and thus, the timing of surgery needs to be coordinated.

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Osteoarticular transfer system (OATS)

Osteoarticular transfer system (OATS) is a surgical procedure to treat isolated cartilage defects which usually 10 to 20mm in size. The procedure involves transfer of cartilage plugs taken from the non-weight bearing areas of the joint and transferring into the damaged areas of the joint.

Find out more about OATS with the following link