Ingalls Offers Cartilage Repair as Alternative to Total Knee Replacement.Cartilage injury is one of the most common sources of knee pain in the United States. In fact, more than two million Americans suffer cartilage injuries each year, resulting in pain and swelling that make it difficult or nearly impossible to maintain an active lifestyle.
Cartilage injury is one of the most common sources of knee pain in the United States. In fact, more than two million Americans suffer cartilage injuries each year, resulting in pain and swelling that make it difficult or nearly impossible to maintain an active lifestyle.
“The cause of damaged articular cartilage (the smooth surface on the ends of our bones) may result from injury, or develop gradually over time with age,” explains Carl DiLella, D.O., orthopedic surgeon on staff at Ingalls Memorial Hospital in Harvey. “Unfortunately, left untreated, damaged articular cartilage may eventually necessitate a partial or total knee replacement.”
But orthopedic experts at the Ingalls Joint Center now offer several revolutionary new procedures to repair or restore damaged cartilage in certain patients – without the need for joint replacement surgery, resulting in less pain and a quicker recovery.
Understanding Articular Cartilage
Articular cartilage is a type of collagen tissue that covers the ends of bones in joints and enables the bones to move smoothly over one another. However, when articular cartilage is damaged through injury or a lifetime of use, it does not heal as rapidly or effectively as other tissues in the body. Instead, the damage tends to progress, allowing the bones to rub directly against each other, resulting in pain and reduced mobility.
“But new techniques using the patient’s own cells and tissues to restore cartilage to weight-bearing sections of bone are giving new hope to the thousands of Americans who annually suffer injuries to the articular cartilage of the knee,” Dr. DiLella said.
Orthopedic surgeons at the Ingalls Joint Center offer several techniques to help the body heal damaged articular cartilage, thereby eliminating pain and restoring mobility. These include:
Micro-fracture
Often the first line of treatment for damaged articular cartilage, the micro-fracture technique helps to stimulate the body to produce its own repair cartilage tissue.
“The repair tissue develops from cells brought to the affected area with blood from the bone underneath the cartilage,” he said. “These cells enter through small holes made in the bone surface by using a small ‘ice pick’ to create micro-fractures.”
Similar to repairing “potholes” in the road, the micro-fracture technique “fills in” small lesions, lessening the probability that the injury will involve the entire cartilage surface. The “potholes” fill in with a form of scar cartilage. While not as durable as the original cartilage, the cartilage that develops from the micro-fractures helps eliminate symptoms in many patients.
Arthroscopic Chondroplasty
Using an arthroscopic approach through one-centimeter incisions, surgeons locate the damaged cartilage tissue and use special shavers to trim away loose or damaged cartilage. This prevents flaking off of the damaged tissue, which often irritates the lining of the joint, leading to pain and swelling.
This clean-up or debridement of the joint surface, is known as chondroplasty.
Osteochondral Autograft
In this technique, the surgeon removes a small cylindrical section of the patient’s own normal cartilage from a small area of the same knee, along with an underlying bone plug. The size of the lesion that can be treated with this method is up to one centimeter in diameter, or slightly larger than a thumbnail.
“This bone and cartilage is then transferred to the defect where a receiving hole has been prepared,” Dr. DiLella said. “The advantage is that normal cartilage is used in the injured area.”
Following a recovery period of up to six weeks that involves no weight bearing on the affected knee, the transferred bone plug with attached normal cartilage heals to the surrounding bone. This surgery, termed the OATS procedure, restores the normal articular cartilage surface within a patient’s knee.
Autologous Cartilage Cell Implantation
For larger articular cartilage defects, one of the more advanced techniques for cartilage restoration available at Ingalls is ACI (Autologous Chondrocyte Implantation).
Originating from Sweden in the mid-1990s, the technique consists of a two-stage process that involves harvesting the patient’s own articular cartilage cells, which are then grown and cultured in a lab.
“The first stage is usually performed when the orthopedic surgeon is initially assessing the knee joint arthroscopically,” he said. “A small amount of the patient’s own articular cartilage is harvested.”
Through cell growth and culturing techniques, the cell chondrocyte number is increased from a few hundred thousand to over 10 million cells, which are then implanted in the affected knee during a second procedure. Periosteum (the natural covering of a bone) is taken from the shin bone and is sewn as a patch over the area of damaged cartilage, creating a pouch. The cultured cartilage cells are then injected into this pouch. Within a few months, the cells grow and organize to reestablish a normal articular cartilage surface within the knee.
Osteochondral Allograft
For larger defects of both bone and cartilage loss, surgeons at the Ingalls Joint Center may custom fit an implant of freshly donated cadaver cartilage and bone. This implant is fit into the prepared articular cartilage-bone defect. Specialized instruments provide for the precise matching of the donated tissue. This procedure has also been shown to be extremely successful in restoring the surface of the affected joint.
“Overall, these procedures mean less pain, a shorter hospital stay and a quicker recovery time for patients with damaged articular cartilage,” Dr. DiLella added.
Cartilage repair and restoration procedures available through the Ingalls Joint Center are most often recommended for 18- to 45-year-old patients with specific types of cartilage injuries. A thorough evaluation by a Joint Center orthopedic surgeon will determine if you qualify for one of these procedures.
For more information, or for a referral to an orthopedic surgeon at the Ingalls Joint Center, please call 800.221.2199.
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