Cartilage Restoration of the Knee

What Kind of Cartilage is in the Knee?

The adult knee contains two major types of cartilage. The medial and lateral menisci are composed of fibrocartilage. These thick cartilaginous structures function to deepen the tibial articulation and allow the rounded femoral condyles to seat with maximum contact area. The menisci also may a role in knee stability. The other major type of cartilage found in the knee is articular cartilage (also known as hyaline cartilage). This is the smooth white covering on the ends of the tibia and femur that allows the knee to glide smoothly through a range of motion with minimal friction.

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Diagramatic example of meniscal and articular cartilage of the knee

Loss of Cartilage

Significant loss of articular cartilage throughout the knee results in osteoarthritis (commonly known as wear and tear arthritis). However, in some young adults there can be an isolated area or region where the articular cartilage is injured. This is a different situation from osteoarthritis because the damage to the articular cartilage is localized and contained in one area of the knee. This localized articular cartilage damage can cause pain, swelling and dysfunction. This condition may also be amenable to cartilage restoration procedures.

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Introperative image demonstrating large chondral (cartilage) defect of medial femoral condyle of the knee

Cartilage Restoration Techniques

Cartilage restoration of the knee involves attempting to stimulate healing of an isolated articular cartilage defect. Often these patients will have relatively normal x-rays however on MRI or arthroscopic evaluation there is noted to be a localized area of damaged cartilage. Most commonly this is on the femoral condyles. In this situation there are multiples options to attempt repair of the defect. Microfracture is an arthroscopic option that involves cleaning the defect of nonviable cartilage and then making small holes in the bony base of the lesion. The point is to cause bleeding at the area of damage.

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Arthroscopic microfracture of a significant chondral defect on the medial femoral condyle of the knee

The blood contains multiple growth factors that can stimulate the body to “heal” the defect. Another option is to take small areas of healthy cartilage from an area of the knee not involved in weight bearing and to transfer these into the defect. In doing this the defect is filled with healthy cartilage and symptoms often decrease.

Autologous chondrocyte implantation (ACI) is another method to address localized areas of cartilage damage in the knee. This procedures requires two separate surgery sessions. In the first surgical setting small portions of healthy cartilage are removed from the knee arthroscopically. This cartilage contains healthy chondrocytes (the cells that produce and maintain articular cartilage). The chondrocytes are taken to a laboratory and grown in vitro for several weeks. After being cultivated the chondrocytes and then implanted into the cartilage defect during a second surgical procedure. All of these procedures have demonstrated reasonable success in treating symptomatic articular cartilage injuries in adults. The choice of procedures is based on several factors and is best made between patient and surgeon during a full consultation. Dr. Wind has had significant experience with all of the above stated procedures during fellowship training as well as in clinical practice.

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Intraoperative image of successful autologous chondrocyte implantation for chondral defect of medial femoral condyle of the knee

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