Articular Cartilage Repair and Restoration

What is an articular cartilage injury?

The knee joint is formed by the articulation between the lower end of the femur (thigh bone), the upper end of the tibia (shin bone), and the patella (kneecap). The articulating surfaces of these bones are covered in a shiny and smooth white connective tissue known as articular cartilage. This cartilage is responsible for protecting these bones and enabling painless joint movement as these bones glide over one another. Although a generally tough tissue, the articular cartilage can become injured from a traumatic event or normal “wear-and-tear” from natural aging. If left untreated, articular cartilage damage can develop into a painful arthritic condition characterized by bone-on-bone contact.

What is the treatment for an articular cartilage injury?

Small articular cartilage defects may respond well to non-surgical therapies such as rest, ice, activity modification, and non-steroidal anti-inflammatory medications (NSAIDs). However, surgical intervention may be necessary for failed non-surgical therapies or substantial articular cartilage damage. There are several surgical procedures available for articular cartilage repair and restoration. It is important to note that patients with singular cartilage lesions are more likely to benefit from surgery than patients with multiple cartilage defects. Dr. Joseph D. Lamplot, orthopedic knee doctor, treats patients in Arlington Heights, Kildeer, Lake Zurich, Barrington, and the surrounding Northwest Suburbs of Chicago, IL, who are in need of articular cartilage repair and restoration.

How is articular cartilage repair and restoration performed?

There are a number of surgical treatment options available for articular cartilage repair and restoration. These restorative techniques are tailored to each patient’s cartilage defects or specific injury and therefore should only be conducted by an orthopedic knee doctor with extensive training in these procedures. After reviewing several patient factors, Dr. Lamplot may implement one or more of the following surgical methods for articular cartilage repair and restoration:

Biologic Augmentation

A relatively new alternative therapy option uses stem cells or platelets harvested from the patient. The stem cells are suspended in a mixture known as Bone Marrow Aspirate Concentrate (BMAC) to promote healing at the injury site. Platelets are fragments of large bone marrow cells that are extracted and concentrated into platelet-rich plasma (PRP). This solution may be  infused directly into the injury site to reduce inflammation and promote healing.

Chondroplasty

This simple surgical method, also known as debridement, involves a small camera (arthroscope) and specialized surgical instruments to remove any damaged cartilage fragments. Any other tissue irregularities, such as loose cartilage bodies, are also removed to prevent further joint irritation. Patients with full-thickness cartilage lesions are poor candidates for this restoration procedure.

Microfracture

Sharp surgical instruments are employed to create small openings within the bone to allow bone marrow and stem cells to infiltrate the knee joint. These cells stimulate new fibrocartilage growth over the exposed bone to repair focal articular cartilage defects. This restorative technique is rarely used by Dr. Lamplot as a primary treatment as studies have found that the new fibrocartilage growth generated from microfracture is not as proficient at weight-bearing as the native cartilage or other cartilage restoration options.

Autologous Chondrocyte Implantation (ACI)

This technique is carried out over two stages. The first stage involves an arthroscopic procedure to harvest healthy cartilage from the patient. These cartilage fragments are sent to a tissue culture lab where the cartilage cells are grown and multiplied. Once a large enough sample is produced, it is implanted into the cartilage defect in a second procedure.

Osteochondral Autograft Transplantation System (OATS)

This procedure replaces the damaged cartilage using cartilage tissue harvested from a non-weightbearing, healthy portion of the patient’s own knee joint. The cartilage taken from the non-injured portion of the patient’s knee is then implanted into the cartilage defect. The benefit of this procedure is that the patient’s own tissue is used to treat the damaged cartilage.

Osteochondral Allograft (OCA)

This procedure replaces the damaged cartilage using a tissue graft from a cadaver. The cartilage graft is shaped to the patient’s specific cartilage defects, making this a highly individualized surgical procedure. The implanted cartilage then grows into the patient’s surrounding healthy cartilage and bone, thereby restoring the native anatomy.

What is the recovery period like after articular cartilage repair and restoration?

The recovery period following articular cartilage repair and restoration is greatly influenced by the specific surgical approach utilized by Dr. Lamplot. The chondroplasty procedure typically yields a full recovery in approximately 6 weeks, whereas the OATS and OCA procedures yield full recoveries in approximately 4-6 months. Regardless of the surgical procedure conducted, the majority of patients in Arlington Heights, Kildeer, Lake Zurich, Barrington, and the surrounding Northwest Suburbs of Chicago, IL can anticipate the following during the recovery process:

• To protect the new cartilage while it heals, weight-bearing is slowly progressed over the first six weeks following surgery. Immediate knee motion is encouraged, and usually a range of motion machine will be prescribed to be used postoperatively.
• Swelling, bruising, pain, and general discomfort are normal after surgery. Any post-operative symptoms can be controlled with rest, ice, compression, and elevation.
• The specific surgery performed often dictates the physical rehabilitation program that is tailored to each patient. The key to a successful recovery following articular cartilage repair and restoration is abiding by postoperative instructions and completing this physical therapy program.

Articular Cartilage Repair Surgeon