Cartilage Repair

Overview

Cartilage repair procedures are designed to restore damaged joint cartilage, alleviate pain, and improve joint function. Cartilage injuries can result from trauma, repetitive use, or degenerative conditions, and if left untreated, can lead to osteoarthritis.

Techniques for Cartilage Repair and Their Indications

• Microfracture: Once a commonly performed procedure, microfracture involves creating small holes in the bone to stimulate new cartilage growth. However, long-term outcomes have shown poor durability, and this technique has largely fallen out of favor. It is typically indicated for small, contained cartilage lesions without significant subchondral bone involvement.

• Osteochondral Autograft Transfer (OATS): This procedure involves transferring healthy cartilage from a non-weight-bearing area to the damaged site. It offers reliable outcomes and a faster return to sports but is limited by the size of the defect due to donor site availability. OATS is most commonly used for small to medium-sized, isolated cartilage lesions with intact surrounding cartilage.

• Osteochondral Allograft Transplantation: A larger graft is sourced from a donor, making this technique suitable for larger cartilage defects that involve the subchondral bone. This procedure is often indicated for larger, uncontained defects, particularly in younger patients with healthy surrounding cartilage.

• Matrix-Induced Autologous Chondrocyte Implantation (MACI): Healthy cartilage cells are harvested, cultured, and then implanted with a supportive scaffold to repair the damaged area. MACI is indicated for larger cartilage lesions with healthy subchondral bone, particularly in younger, active patients.

• Particulate Juvenile Cartilage: Cartilage from juvenile donors is implanted to promote cartilage growth, particularly in smaller lesions. This technique is often considered when treating small defects with healthy surrounding tissue.

• Extracellular Matrix-Based Microfracture Augmentation: This newer technique enhances microfracture outcomes by applying a biologic scaffold to support cartilage regeneration. It is typically indicated when microfracture is performed in areas with subchondral bone integrity to improve long-term results.

The Procedure

Cartilage repair procedures can be performed arthroscopically or through an open approach, depending on the technique and location of the defect. The damaged cartilage is prepared, and the chosen repair method is applied.

Recovery Process

Recovery varies based on the procedure performed but typically includes restricted weight-bearing, physical therapy, and gradual return to activities over several months.

Risks and Considerations

Risks include incomplete cartilage regeneration, graft failure, infection, and joint stiffness. Choosing the appropriate technique for each patient's specific condition helps mitigate these risks.

Conclusion

Cartilage repair techniques have evolved significantly, offering patients improved options to restore joint function and delay arthritis progression. If you are experiencing joint pain due to cartilage damage, contact our office to discuss your treatment options.