Articular cartilage is a firm, rubbery material that covers the ends of bones in the knee joint. It reduces friction in the joint and acts as a "shock absorber." When cartilage becomes damaged or deteriorates, it limits the knee's normal movement and can cause significant pain. If damaged cartilage is not treated appropriately, it can worsen and eventually require knee replacement surgery.
Who is ideal patient?
The treatment is recommended for patients with knee cartilage damage or deterioration caused by:
- Osteochondritis dissicans (OCD)
- Injury or trauma, including sports injuries
- Early osteoarthritis without malalignments
Microfracture: This procedure is performed arthroscopically. During microfracture, small holes are created in the knee bone. The surface layer of the bone, called the subchondral bone, is hard and lacks good blood flow. Creating holes in the bone allows bleeding. Blood contains bone marrow cells that stimulate cartilage growth and form fibrocartilage, which covers the injured area.
Autologous Chondrocyte Transplantation (ACI): This is a two-step procedure that takes several weeks to complete. First, healthy cartilage cells are arthroscopically removed from a non-weight bearing area of the knee. The cells are then grown in the laboratory for around six to eight weeks.
An open surgical procedure, called an arthrotomy, is then done to implant the newly grown cells. A layer of tissue that covers the outer surface of bone, called periosteum, is sewn over the area and sealed with fibrin glue. The newly grown cells are injected into the defect under the periosteum.
BMAC or Stem cell treatment: Bone marrow aspiration is a minimally invasive procedure used to collect bone marrow. BMAC (Bone Marrow Aspirate Concentrate) is harvested from patients iliac crest and concentrated it to the optimal level while keeping all cell types, including stem cells and other cells that perform distinct functions in the body, in this situation cartilage.
This is then injected into the defective area and allowed to transform into the articular cartilage.
Osteochondral Autograft Transplantation (Mosaicplasty)
This procedure is typically performed through an open incision. In some cases, it is performed arthroscopically. Osteochondral autograft transplantation involves transferring healthy cartilage tissue, called a graft, from one part of the knee to the damaged area. The graft is taken as a "plug" of cartilage and underlying bone.
A single plug of cartilage may be transferred or multiple plugs may be transferred in a procedure called mosaicplasty. Each plug is a few millimeters in diameter. When multiple plugs are moved to the damaged area, it creates a mosaic appearance.