Cartilage is the protective surface that covers the ends of the bones and helps the knee joint move smoothly without pain. Cartilage can become damaged with age, wear and tear, or injury.
For certain patterns of cartilage wear or injury, cartilage repair, transfer, or transplant procedures may help restore the cartilage surface, although they do not make the joint normal again.
What Is Arthroscopic Cartilage Repair and Transplantation?
Dr. Chudik performs cartilage repair and transplant procedures with the assistance of an arthroscope, a small camera inserted through small incisions that allows him to view the inside of the knee joint.
Several cartilage restoration options are available depending on the location and severity of the cartilage damage:
- Abrasionplasty: The cartilage defect is cleaned back to stable borders, and the base of the lesion is abraded to a bleeding surface so blood and marrow elements can fill the defect.
- Microfracture: Deeper holes are created to access blood and marrow components in a technique similar to abrasionplasty.
- Autologous Chondrocyte Implantation: This two-stage procedure first removes cartilage cells and allows them to grow in a laboratory. During a second surgery, a thin layer of periosteal tissue or a synthetic collagen matrix is placed in the cartilage defect, and the cells are introduced into the area in an attempt to regrow and fill the defect.
- Osteochondral Autologous Transfer (OATs): A piece of healthy bone and cartilage is taken from a lesser weight-bearing area of the knee and transferred into the damaged area.
- Osteochondral Allograft Transplant: For larger defects, a bone and cartilage plug from a cadaver is transplanted into the cartilage-deficient area.
Who Is a Candidate?
Cartilage repair, transfer, or transplantation may be considered for patients with certain patterns of cartilage injury or wear.
Contraindications include:
- Infection of the knee
- Inability or unwillingness to complete an appropriate postoperative rehabilitation program
- Diffuse, advanced arthritis of the knee without mechanical symptoms
The specific cartilage restoration procedure depends on the location and severity of the cartilage damage.
How the Procedure Is Performed
Dr. Chudik performs cartilage repair and transplant procedures with the assistance of an arthroscope. Arthroscopic shavers and cutting instruments are used to remove and contour damaged cartilage and meniscus tissue when appropriate.
The specific surgical technique depends on the cartilage injury:
- Abrasionplasty removes unstable cartilage and prepares the underlying surface to allow bleeding and marrow elements into the defect.
- Microfracture creates deeper holes to access blood and bone marrow components.
- Autologous chondrocyte implantation is performed in two stages, first harvesting cartilage cells and later implanting the grown cells into the cartilage defect.
- OATs transfers healthy bone and cartilage from a lesser weight-bearing area of the patient’s knee into the damaged area.
- Osteochondral allograft transplantation uses donor bone and cartilage to replace a larger cartilage defect.
The surgery is generally performed as an outpatient procedure under general anesthesia with a femoral nerve block.
Recovery and Rehabilitation
Recovery depends on the severity of the cartilage and meniscus damage and the procedure performed.
Following surgery:
- Arthroscopic wounds should be kept clean and dry for three days; wounds from an open procedure should remain clean and dry for 14 days
- Patients may shower after the appropriate wound-care period, but incisions should not be submerged in water for at least three weeks
- Crutches are typically used for approximately three to six weeks depending on the severity of the cartilage and meniscus damage
- Physical therapy should begin two to three days after surgery and continue for approximately three to four months depending on severity
- Standing and walking should be minimized for six weeks, followed by a gradual progression of activity over three to four months
Patients may return to sports and activities when there is no pain and full knee range of motion, muscle strength, endurance, and functional use have been restored.
For many knees, lifestyle changes may also be recommended to help maintain knee health as long as possible.
Risks and Outcomes
Potential surgical risks and complications include:
- Infection
- Knee stiffness or loss of motion
- Failure of cartilage implants to heal properly
- Continued pain and progressive arthritis
- Weakness of the quadriceps muscles if proper rehabilitation is not completed
- Persistent swelling and symptoms
- Possible need for total knee replacement
Cartilage restoration procedures may help restore the cartilage surface for certain patterns of wear or injury, but they do not return the joint surface to its original normal state.
Why Dr. Chudik for Arthroscopic Cartilage Repair and Transplantation
Dr. Chudik performs several cartilage repair, transfer, and transplant procedures and selects the technique based on the location and severity of the cartilage damage.
Using arthroscopic evaluation, he can assess the damaged cartilage and meniscus and determine whether treatment such as abrasionplasty, microfracture, autologous chondrocyte implantation, osteochondral autologous transfer, or osteochondral allograft transplantation is appropriate.