What is the Treatment of Cartilage Injuries?
Articular or hyaline cartilage is the tissue lining the surface of the two bones in the knee joint. Cartilage helps the bones move smoothly against each other and can withstand the weight of the body during activities such as running and jumping. Articular cartilage does not have a direct blood supply to it so has less capacity to repair itself. Once the cartilage is torn it will not heal easily and can lead to degeneration of the articular surface, leading to development of osteoarthritis.
Treatment of cartilage injuries in the knee aims to restore the cartilage surface, relieve pain, and improve joint function. Cartilage injuries can range from minor damage to significant defects. Treatment options vary based on the extent and location of the injury, the patient's age, activity level, and overall health. Cartilage replacement surgery is typically the treatment of choice to replace the worn-out cartilage with new cartilage to restore knee function.
What are the Indications for Treatment of Cartilage Injuries?
The damage in articular cartilage can affect people of all ages. It can be damaged by trauma such as accidents, mechanical injury such as a fall, or from degenerative joint disease (osteoarthritis) occurring in older people. Treatment such as cartilage replacement is usually indicated to treat small areas of cartilage damage usually caused by sports or traumatic injuries. It is not indicated if you have advanced arthritis of the knee.
What Does Preparation for Treatment of Cartilage Injuries Involve?
In general, treatment of cartilage injuries may involve the following steps:
- A thorough consultation with your orthopaedic surgeon who will evaluate your medical history, medications, allergies, knee condition using imaging tests like MRI or CT scans to assess the extent of cartilage damage, and overall health to determine if you are a suitable candidate for AutoCart cartilage restoration.
- Your surgeon will provide other specific preoperative instructions, such as:
- Medication management: Adjusting or stopping certain medications that can thin the blood and increase the risk of bleeding during surgery or interfere with healing.
- Fasting: Typically, you will be asked to fast for a certain period before surgery.
- Smoking cessation: If you smoke, quitting or reducing smoking can improve surgical outcomes and healing.
What are the Treatment Options for Cartilage Injuries?
Patients with articular cartilage damage experience symptoms such as joint pain, swelling, stiffness, and a decrease in range of motion of the knee. Treatment typically involves cartilage replacement in which the damaged or worn-out cartilage is replaced with healthy cartilage typically obtained from the patient (autograft) or in some instance a donor (allograft). Cartilage replacement is usually performed to treat patients with small areas of cartilage damage typically caused by sports or traumatic injuries. It is not indicated for those patients who have advanced arthritis of the knee.
Cartilage replacement helps relieve pain, restore normal function, and can delay or prevent the onset of arthritis. The goal of cartilage replacement procedures is to stimulate growth of new hyaline cartilage. Various arthroscopic procedures involved in cartilage replacement include:
- Microfracture: Microfracture involves creating numerous tiny holes in the injured joint surface using a special tool called awl. The holes are made in the bone under the cartilage, called the subchondral bone. This creates new blood supply to the cartilage, which stimulates the growth of new cartilage.
- Drilling: This procedure is similar to microfracture where multiple holes are created in the injured joint area using a surgical drill or wires.
- Abrasion arthroplasty: This procedure is similar to drilling but involves the use of high-speed burs to remove the damaged cartilage.
- Autologous chondrocyte implantation (ACI): This is a two-step procedure, where the healthy cartilage cells are removed from the non-weight-bearing joint, grown in the laboratory and then implanted in the cartilage defect during the second procedure. During this procedure, a patch is harvested from the periosteum, a layer of thick tissue that covers the bone, and is sewn over the defective area using fibrin glue. The new cartilage cells are then injected under the periosteum into the cartilage defect to allow the growth of new cartilage cells.
- Osteochondral autograft transplantation: In this procedure, plugs of cartilage are removed from the non-weight-bearing areas of your own knee and transferred to the damaged areas of the joint. This method is used to treat smaller cartilage defects since the graft that is taken from your own body will be limited.
- Osteochondral allograft transplantation: In this procedure, healthy cartilage tissue is taken from a donor from the bone bank. This is used as a graft and transplanted to the area of cartilage defect.
What Does Postoperative Care for Cartilage Injuries involve?
After surgery, you will be taken to the recovery room where medical staff will monitor your vital signs until you wake up. Once awake, you will receive instructions on postoperative care, including pain management, activity restrictions, and wound care. You will undergo a structured rehabilitation program supervised by physical therapists. This program includes exercises to promote healing, strengthen the muscles around the knee, improve range of motion, and gradually reintroduce weight-bearing activities. Due to the minimally invasive nature of the surgery, you should be discharged from the hospital in a day or two. Your orthopaedic surgeon will schedule follow-up appointments to monitor your progress, assess the success of the cartilage restoration, and make any necessary adjustments to your rehabilitation plan.
