Surgery and Cartilage Transplantation
Cartilage allows a joint to glide smoothly and acts as a cushion between bony structures. As we age, it’s susceptible to wear and tear, or it can be damaged from injury. Cartilage transplants can help reduce pain and increase function by restoring the joint’s healthy cartilage. The procedure may slow the progression of osteoarthritis and delay the need for more invasive procedures. This is particularly applicable in patients considered too young to undergo total joint replacement.
Advances in preserving donor tissue and improved implantation techniques have vastly improved the predictability and success of cartilage transplantation.
Although most frequently used in the knee, cartilage transplantation may also benefit patients with early joint damage in the shoulder, elbow and ankle. These procedures are not applicable for patients for whom total joint replacement is indicated.
Cartilage transplantation is more successful in patients under 50 years of age. Careful evaluation of many aspects of a joint injury are necessary to develop a successful cartilage treatment plan.
The original standard treatment for small cartilage injuries was a technique known as micro-fracture. This involves shaving the area of damaged cartilage and mechanically stimulating the underlying bone and marrow. This causes bone marrow to produce a cartilage substitute. This so-called fibrocartilage acts as a new cushion for the knee, restoring more normal joint structure and function. Newer research has found combining micro-fracture with other juvenile cartilage treatments is superior to micro-fracture alone and is the treatment offered at Orthopedic Specialists of Seattle.
Osteochondral Autograft Transplantation
In specific situations a patient’s own cartilage may be harvested and surgically transferred from one part of the joint to another area. The surgeon removes a small piece of healthy cartilage and bone, typically from a non-weight-bearing area of the joint. The graft will then be used to reconstruct the area of damaged cartilage. This procedure is being supplanted by allograft transplantation (discussed below) and micro-fracture plus with similar success and fewer complications.
Osteochondral Allograft Transplantation
Just like an organ, such as a heart or kidney, cartilage can be transplanted from another person. The donor cartilage is shaped and transplanted into the area of cartilage damage, restoring the smooth healthy joint surface. This procedure is well suited for active individuals and for those who have failed other cartilage restorative procedures. Unlike other forms of tissue transplantation, rejection doesn’t occur and immunosuppressive medications are not required.
Autologous Chondrocyte Implantation
This is a two-stage procedure that requires harvesting of cartilage from a patient’s knee during the first procedure. The cartilage cells are grown in a lab and implanted into the joint during a second surgical procedure. This procedure is ideal for cartilage defects in the patellofemoral joint (behind the knee cap) or in young patients who have lost areas of cartilage and who have relatively normal underlying bone.
This procedure is generally reserved for patients who have had the meniscus completely removed in a previous surgery and have residual pain. Donor meniscus cartilage is tested to be free of transmittable disease. The meniscus can be accurately matched and sized to provide an anatomic replacement. Rejection does not occur with cartilage transplantation, and immunosuppressive therapy is not required after surgery.
The procedure can be performed as a minimally invasive arthroscopic procedure using only small incisions. The transplanted meniscus is very similar to the patient’s original healthy meniscus cartilage. This leads to a more stable and less painful knee that might otherwise have developed progressive arthritis.
Dr. Grant Garcia can evaluate you and your needs to find the best treatment plan moving forward.