Cartilage repair is a procedure that helps restore the cartilage in the knee. Cartilage repair can be done on an otherwise healthy knee that has not been affected by osteoarthritis.
Cartilage is a rubber-like material that coats the ends of the bones that connect to the knee joint: the femur in the thigh, and the tibia, and fibula in the calf. The cartilage in this joint absorbs shock to the knee, reduces friction as the knee moves, and cushions the joint. When this cartilage is damaged, it can lead to a locking feeling in the knee or pain during movement. In some cases, these symptoms can be so severe that they make it hard to use the joint at all.
Cartilage does not have its own blood supply, so once it is damaged or injured, it will likely stay the same or get worse without treatment. Most of the time, early treatment and repair can help reduce damage. If damage goes on without treatment, it may lead to a knee replacement surgery.
Who can cartilage repair help?
Cartilage repair can help people who have damaged cartilage because of:
- Overuse of the joint (usually a repetitive motion)
- Injury or trauma to the joint
- Birth defects
- Hormonal disorders that may affect bone and joint development
This surgery is not for people whose cartilage is damaged because of osteoarthritis (a condition that deteriorates the cartilage as you age).
Cartilage repair is a fairly low-risk procedure that has very few complications. As with any surgery, there are certain risks, which may include:
- Complications due to anesthesia
There are these general risks to the procedure. There may also be some risks or side effects that are unique to an individual’s condition or how severe the injury is. Discuss these risks with the doctor to better decide on the best choice for treatment.
The main benefits to cartilage repair are that it will help increase the range of motion in the knee and also help reduce pain.
There are different ways to prepare for the procedure, depending on how it is performed:
- Your doctor may ask you to stop taking certain medications for a period before your procedure.
- If you smoke, quitting will help you heal better and faster.
- Your doctor may also ask you to not eat or drink anything for a certain time before the procedure.
- Talk to your doctor about the specific requirements based on how severe your condition is and how the procedure will be performed.
There are a few different types of procedure for cartilage repair. To determine which one may be the best for you, the doctor may order an MRI.
The MRI will give your doctor an image of the inside of your knee, which will help them figure out the kind of damage you have, where it is, and what procedure can work best for you.
Most knee procedures are performed arthroscopically [ahr-throw-SKAH-pihk-lee], which means the doctor will put small tools into the knee via small incisions (cuts) rather than cutting the entire knee open. This type of procedure reduces the risk of bleeding and infection and also helps the knee heal faster. In rare cases, the doctor may need to cut the whole knee open. Talk to your doctor before your procedure to learn more about what procedure will be best for you.
Depending on the type of procedure, you may have a local anesthesia, meaning the area that will be operated on is numbed, but you are awake, or you may have a general anesthesia where you go to sleep for the surgery.
As there are different types of procedures depending on the level of damage, make sure you talk to your doctor about what to expect for your procedure.
Common forms of the procedure
Some of the most common procedures are:
- Autologous [AW-toh-loh-gus] Chondrocyte [KON-droh-syte] Transplantation (ACT). This is a 2-step procedure that is performed over a few weeks. First, healthy cartilage is removed, then grown in a lab. It takes about 6 to 8 weeks to grow more cartilage. The first part of this procedure is performed arthroscopically. After a few weeks, an open surgical procedure is done to insert the new cartilage into the knee at the affected area. In this procedure, a layer of new tissue is sewn over the bone, and the newly-grown cartilage is injected into this pocket.
- Cell-based Cartilage Resurfacing. This is still an experimental procedure, so it may or may not be offered by your doctor and covered by your insurance. Most of the time, you will have to participate in a clinical trial to access this method of treatment. Similar to the previous procedure, healthy cartilage is taken from the body and grown in a lab and then put into the knee. In this procedure, the method used in the lab for growing the cartilage is different. Also, a new type of glue is used to attach the cartilage, which will mature and integrate with the old cartilage in a few months.
- Meniscus [meh-NIS-kiss] Transplant. This procedure involves implanting a new meniscus into the knee. The new meniscus comes from a cadaver donor (someone who has died). This procedure is usually performed using a small incision. The donor meniscus is stitched in place.
- Microfracture. For this procedure, small holes are made in the knee bone, which causes the knee to bleed. The increased bleeding helps stimulate cartilage growth. This procedure is done arthroscopically.
This list does not include all types of procedures that your doctor may choose from to do the cartilage repair. Talk to your doctor to make sure you understand the recommended procedure. Take the time to ask all of your questions to make sure you know what will happen in your exact situation.
Depending on the type of procedure, you may see improvement as early as a few weeks, or it may take up to a year. Talk to your doctor about the type of procedure that is recommended for you and what you can expect for your results.
After a cartilage repair procedure, you will need to keep weight off the knee that was worked on. Your doctor will likely give you crutches, which you will need to use until your doctor tells you that you don’t need them anymore.
Your doctor will closely watch your recovery to make sure everything is healing properly. You may have several follow-up visits, which you should make sure to attend. It is important to follow your doctor’s orders to make sure that you heal properly.
Make sure you talk to your doctor about the follow-up requirements for your specific procedure to make sure you understand all of the requirements.