Cartilage Repair and Restoration
Written by: Evan D. Ellis, M.D.
As we get older, the cartilage surfaces within our knees can start to deteriorate or become damaged. This can be caused by aging, genetics, or injury. There have been major advances in the past ten years to help repair and restore the articular cartilage of the knee and to repair the meniscus, too. The articular cartilage is the smooth, shiny material on the ends of our bones that acts like a brake pad. When this wears down, this is referred to as osteoarthritis. The meniscus consists of two C-shaped discs within the knee that are made of a material called fibrocartilage. The meniscus acts as a shock absorber within the knee.
There are a number of different methods to restore the articular cartilage, all of which involve a different method of treatment and a slightly different indication for their use.
The first type of treatment is referred to as a microfracture procedure. This is a surgical procedure that is effective for small- to medium-sized, isolated injuries to the articular cartilage. A simple arthroscopy of the knee is performed, the defect is cleaned of any loose debris, and then small poke holes are created and evenly spread throughout the defect. This allows for stimulation of the marrow within the bone, bleeding into the defect, and the ultimate development of a “scab” of cartilage that fills the defect. This procedure has been around the longest, and it is typically the procedure that all others are compared to. Microfracture has an excellent track record and is often the right choice for a straightforward, isolated injury.
The second type of treatment is referred to as an OATS procedure. In this procedure, a dowel of bone and cartilage are taken from either a different, and less important, area within your knee, or from a cadaveric knee. This procedure can be used for larger areas of injury or for areas that are more difficult to fill in. This procedure is much like filling a pothole with new bone and cartilage.
Another type of procedure is referred to as ACI or MACI. This stands for autologous chondrocyte implantation. In this procedure, cartilage cells are harvested at the time of a first arthroscopy. The cells are then grown in a lab, and once they have proliferated enough, they are then implanted during a second procedure. This type of procedure can be used to fill defects in very difficult locations that don’t always respond well to the procedures mentioned above.
There are many additional procedures that we perform that use various types of cartilage transfers, including the implantation of embryonic cartilage cells, injections of bone marrow aspirates, and the harvesting of pluripotential growth factors. These are very cutting-edge, but we have extensive experience in their use and application.
The meniscus is a rubbery shock absorber within the knee that can very commonly tear. Due to the poor blood supply of the meniscus, most tears will need to be trimmed back to stable tissue, and your pain will be eliminated. However, we have developed new techniques to try and sew the meniscus back in place so that you can keep as much of your meniscal tissue for as long as possible.
Consider visiting one of our fellowship-trained sports medicine providers specializing in cartilage repair, Jerome J. DaSilva, M.D., F.R.C.S.C. or myself, Evan D. Ellis, M.D., to discuss and discover the best treatment option for you. To schedule an appointment in Vancouver, Portland, or Lake Oswego, call 1-800-REBOUND or request an appointment online.