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Cartilage Restoration

Were you a competitive athlete? Did you play sports in high school, college, or even at a professional level? Have you ever been told that you have had a knee injury with a torn meniscus? Do you have a long-standing history of knee pain? Have you been told that you will have to live with your knee pain?

If you answered yes to any or all of these questions, cartilage restoration maybe an option for you.

Every year, more than 5 million Americans have knee injuries, with more than 2 million requiring a physician evaluation to determine the amount of knee damage.

KNEE JOINT

Some of these knee injuries are easily treated with physical therapy and modification of activity, whereas others require surgery to evaluate and treat the meniscal or articular cartilage damage. If the articular or meniscal damage is left untreated, it can lead to chronic, degenerative changes which ultimately can result in knee replacement. But new and exciting strategies are being developed to treat knee injuries early and aggressively. Many of these new options have become available only in the last few years and these new options have given patients the best chance of avoiding debilitating knee problems later in life.

 

CARTILAGE

A) Articular cartilage / This is the cartilage that covers the end of the bones in the joints. It is very smooth and enables movement and acts as a protective substance to prevent the bones from rubbing up against each other. This substance is very slippery. In a healthy articular cartilage, it allows the two bones to slide adjacent to one another. When there is damage to the articular cartilage, this is commonly termed "arthritis". This creates a rough, painful surface.

B) Meniscus cartilage / There is a medial and a lateral meniscus. These are "C" shaped pads found between the femur and the tibia. The inner is the medial and the outer is the lateral. They serve to cushion the joint and act as shock absorbers.

Knees are designed to withstand forces of a lifetime such as walking, running, sitting and standing. However, in the event that the joint's delicate balance is disturbed, an injury may result causing damage to the meniscus or to the articular cartilage. A meniscus, at times, can tear and can interfere with the normal shock absorbing effect of the cushion. An articular cartilage can also tear giving a defect and expose the underlying bone. An injury is not limited to major trauma. It can occur with normal, day to day activities such as squatting, climbing, or repetitive injury or over training. Other activities or even incorrect weight training can cause a lifetime of problems. Over time, small defects in the meniscus or the articular cartilage can propagate and can lead to more widespread damage and eventually the pain and permanent disability of arthritis. This type of arthritis is called osteoarthritis.

NEW APPROACHES

Meniscal cartilage tears represent the most common knee injury resulting in surgery in North America. Meniscus tears can occur with activities of daily living without any specific trauma as well as with trauma that could occur with different sporting activities or even work place injuries. Once a meniscus is torn, the body's natural response is to develop pain as well as swelling. Patients often complain that the knee may "lock", give way, or go out. Once a meniscus is torn, it loses its normal "cushioning affect". This causes the body's weight to distribute unevenly. As a result of this uneven stress, over time, the articular cartilage can wear down which can lead to degenerative arthritis. At Oklahoma Sports & Orthopedics Institute, we do everything possible to repair or even replace torn meniscal cartilage. In the past, a meniscus tear would result in a large incision and excising the entire meniscus. This subsequently changed to performing a meniscus resection through the arthroscope. Today, as the physicians recognize the importance of the meniscus, we have technology not only to remove the injured meniscus through an arthroscope but to repair a meniscus or even transplant a new meniscus into a damaged area.

REPAIRING THE MENISCUS

The meniscus has excellent blood supply in the outer 302476526423f the meniscus. If you have a tear in this area, the orthopedic surgeons at Oklahoma Sports & Orthopedics Institute are able to repair it and give a high probability of healing. If the meniscus heals, this can stop the progression of the arthritis which we previously discussed. Meniscus repair can be done arthroscopically and has an excellent success rate.

MENISCUS TRANSPLANT

In some patients whose meniscus is not repairable, and the entire meniscus has been resected, the physicians are able to "transplant a donated meniscal cartilage". This is called a meniscal allograft transplant. The majority of this procedure is done through the arthroscope. However, a small incision is made to introduce the cartilage into the knee joint. The surgeons transplant donated meniscal cartilage which has been tested to insure that it is free of any transmittable disease. Unlike other forms of tissue transplant, this does not require that patients be on medications to prevent tissue rejection

ARTICULAR CARTILAGE


REPAIRING ARTICULAR CARTILAGE

The thick elastic tissue that caps the ends of bones is called the articular cartilage. It works in conjunction with the meniscus cartilage to function as a shock absorber for the knee allowing the knee to withstand the day to day pressures. Like meniscal cartilage, the articular cartilage can become damaged through the trauma of injury or as a result of day to day wear and tear that occurs over a lifetime.

EARLY INTERVENTION

The orthopedic surgeons at Oklahoma Sports & Orthopedics Institute have a variety of options available to the patients who have had damage to the articular cartilage. When a patient has a full thickness defect, these are called focal chondral defects. Left untreated, these can progress to osteoarthrosis in a short period of time.


CARTILAGE RESTORATION METHODS USED:

A) Arthroscopic Debridement and Microfracture in a patient who has an isolated focal chondral defect, the physician can insert a small camera to locate the damaged tissue and debride the torn areas away. They then make small holes in the bone. This is called a "microfracture". The purpose of the microfracture is to allow these holes to serve as channels allowing the bone marrow cells to propagate through the channels to the hole. These bone marrow cells will then form a cartilage covering that resembles normal articular cartilage.

B) Osteochondral Autograft/ In this technique, the surgeon removes a piece of cartilage from a portion of the knee that does not bear weight and transfers the plug to a damaged portion in the knee. This is very similar to a hair plug transfer. This has excellent results in full thickness cartilage defects in areas less than 2 square centimeters.

C) Allograft Reconstruction/ If there is a focal defect larger than 2 square centimeters this is too large for an osteochondral autograft and a allograft reconstruction is an excellent option. The surgeons will implant a piece of freshly donated cartilage and bone from a cadaver into the patient's bone. The donated cartilage and bone will grow into the patient's bone as it were the patient's own. This has excellent results for patients who have large defects.

D) Autologous Chondrocyte Implantations. The autologous chondrocyte implantation is also known as the Carticel procedure. This was developed in Sweden over 20 years ago. It was approved by the FDA in 1995. This is the most exciting area of cartilage restoration to date. This procedure, as a result of bio-technology, uses the patient's own cartilage to restore defects in the joint surface. This is a 2 stage procedure. In the first stage, the surgeon harvests a few small samples of cartilage cells from a portion of the knee that is non-weight bearing. The cells are then placed into a sterile test tube and sent to a laboratory where through advanced culturing techniques, the cell numbers increase from a few hundred thousand cells to over 12 million cells. The surgeon then returns at a later date and re-implants these cells into the knee joint through a second, open operative procedure. Then, a soft tissue flap is sewn over the defect. The cells are placed into the defect where they begin to grow and multiply. The uniqueness of this procedure is that the cells which fill the defect are the patient's own cartilaginous cells and if heal as planned, they return to almost a pre-injury status, re-establishing the articular cartilage.

ESTABLISHED ARTHRITIS

For patients who experience established arthritis and are not candidates for the prior cartilage restoration techniques, the physicians at Oklahoma Sports & Orthopedics offer a wide range of methods to help relieve the pain and restore function in the quickest, safest amount of time as possible.