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Articular Cartilage Restoration Procedures
Articular cartilage is the smooth, white tissue that covers the ends of bones where they come together to form joints. Healthy cartilage in our joints makes it easier to move. It allows the bones to glide over each other with very little friction.
Articular cartilage can be damaged by injury or normal wear and tear. Because cartilage does not heal itself well, doctors have developed surgical techniques to stimulate the growth of new cartilage. Restoring articular cartilage can relieve pain and allow better function. Most importantly, it can delay or prevent the onset of arthritis.
Surgical techniques to repair damaged cartilage are still evolving. It is hoped that as more is learned about cartilage and the healing response, surgeons will be better able to restore an injured joint.
Hyaline Cartilage
The main component of the joint surface is a special tissue called hyaline cartilage.When it is damaged, the joint surface may no longer be smooth. Moving bones along a tough, damaged joint surface is difficult and causes pain. Damaged cartilage can also lead to arthritis in the joint.
The goal of cartilage restoration procedures is to stimulate new hyaline cartilage growth.
Identifying Cartilage Damage
In many cases, patients who have joint injuries, such as meniscal or ligament tears, will also have cartilage damage. This damage may be hard to diagnose because hyaline cartilage does not contain calcium and cannot be seen on an X-ray.
If other injuries exist with cartilage damage, doctors will address all problems during surgery.
r knee to slip, pop, or lock.
Surgical Procedures
Many procedures to restore articular cartilage are done arthroscopically. During arthroscopy, your surgeon makes three small, puncture incisions around your joint using an arthroscope.
Some procedures require the surgeon to have more direct access to the affected area. Longer, open incisions are required. Sometimes it is necessary to address other problems in the joint, such as meniscal or ligament tears, when cartilage surgery is done.
In general, recovery from an arthroscopic procedure is quicker and less painful than a traditional, open surgery. Your doctor will discuss the options with you to determine what kind of procedure is right for you.
The most common procedures for cartilage restoration are:
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Microfracture
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Autologous Chondrocyte Implantation (ACI)
Microfracture
Steps of the microfracture technique. Left: Damaged cartilage is removed. Center: Awl is used to make holes in the subchondral bone. Right: Healing response brings new, healthy cartilage cells.
The goal of microfracture is to stimulate the growth of new articular cartilage by creating a new blood supply. A sharp tool called an awl is used to make multiple holes in the joint surface. The holes are made in the bone beneath the cartilage, called subchondral bone. This action creates a healing response. New blood supply can reach the joint surface, bringing with it new cells that will form the new cartilage.
The goal of microfracture is to stimulate the growth of new cartilage by creating a new blood supply.
A sharp tool called an awl is used to make multiple holes in the joint surface. The holes are made in the bone beneath the cartilage, called subchondral bone. This creates a healing response. New blood supply can reach the joint surface. This will bring new cells that will form cartilage.
Microfracture can be done with an arthroscope. The best candidates are young patients with single lesions and healthy subchondral bone.
Single Stage Autologous Chondrocyte Implantation (ACI)
This technique is performed by harvesting the patients healthy tissue off of the non weight bearing surface of the articular cartilage and then processing it into a new substance that fills the area of the defect. Previously preformed in a 2 step process, Dr. Butkovich is one of the first Orthopaedic Surgeons in the Hampton Roads area to perform this in a single stage procedure
Numerous factors are considered when evaluating these disorders for the correct treatment option. A comprehensive physical exam as well as an MRI to measure the size and depth of the lesion will aid in determining the best procedure for each patient.
Rehabilitation
After surgery, the joint surface must be protected while the cartilage heals. Depending on the location of your lesion you may not be able to put weight on the affected leg for the first 6-8 weeks. You will need to use crutches to move around after surgery. Physical therapy will help restore mobility to the affected joint. During the first weeks after surgery, you may begin continuous passive motion therapy.
As healing progresses, your therapy will focus on strengthening the joint and the muscles that support it. It may be several months before you can safely return to sports activity.