Treatment options
Several procedures can help repair an articular cartilage injury in your knee. Your doctor can help you decide which is best for you based on your age, as well as the location and size of the injury and your expectations.
Remember, if you postpone treatment, your injury may get worse and over time may become more difficult to repair.
Articular Cartilage Repair
Arthroscopic Chondroplasty (Debridement and Lavage)
During an arthroscopic procedure, the surgeon locates and trims the damaged cartilage, then irrigates the area with sterile water. This cleaning of the joint surface may also be referred to as “debridement and lavage.” Chrondoplasty may relieve pain, but it does not actually repair the damaged cartilage.
Marrow Stimulation Repairs (Abrasion Arthroplasty, Microfracture, Subchrondal Drilling)
These procedures are used to repair small cartilage injuries. They allow the body’s own marrow stem cells to produce scar tissue and repair the damaged cartilage. The surgeon uses a surgical instrument to create tiny holes or breaks in the bone underneath the damaged cartilage. Blood seeps out of these fractures and creates a clot that releases cartilage-building cells. The most common marrow stimulation procedure is called microfracture.
Osteochondral Autograft
To repair small cartilage injuries, the surgeon can remove a small plug of a patient’s own healthy cartilage from a non-weight-bearing area of the knee joint and insert it into the injured area. This technique is similar to a hair-plug transfer.
Osteochondral Allograft
For very large cartilage injuries and those that involve bone and cartilage loss, the surgeon may obtain tissue from a donated cadaver. The implant contains portions of both bone and cartilage, and may provide relief from injuries that penetrate the bone.
CARTICEL is a biologic product used to repair articular cartilage injuries in adults who have not responded to an arthroscopic or other surgical repair procedure. It uses your body’s own cultured cells to regenerate the articular cartilage in your knee during a surgical procedure called autologous chondrocyte implantation (ACI). CARTICEL is the name of the cells that are grown from the samples (or biopsy) taken from your knee. When implanted into a cartilage injury, these cells can form new hyaline-like cartilage. CARTICEL poses little risk of disease transmission since it comes from your own tissue, and is not transplanted from an unrelated donor. CARTICEL is not indicated for the treatment of cartilage damage associated with generalized osteoarthritis.
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Important Safety Information
CARTICEL is for autologous use and is indicated for the repair of symptomatic, cartilage defects of the femoral condyle (medial, lateral or trochlea), caused by acute or repetitive trauma, in patients who have had an inadequate response to a prior arthroscopic or other surgical repair procedure (e.g., debridement, microfracture, drilling/abrasion arthroplasty, or osteochondral allograft/autograft). CARTICEL should only be used in conjunction with debridement, placement of a periosteal flap and rehabilitation. The independent contributions of the autologous cultured chondrocytes and other components of the therapy to outcome are unknown. It is not indicated for the treatment of cartilage damage associated with generalized osteoarthritis. It is not recommended for patients whose knee meniscus has been surgically removed unless the patient has undergone surgical reconstruction prior to or concurrent with CARTICEL implantation.
Pre-existing conditions including meniscal tears, joint instability or malalignment of the joint should be corrected prior to or concurrent with CARTICEL implantation. It should not be used in patients with a known history of hypersensitivity to gentamicin, other aminoglycosides or materials of bovine origin. CARTICEL is not routinely tested for transmissible infectious diseases and may transmit disease to the healthcare provider handling CARTICEL. In addition, it should not be used in patients who have previously had cancer in the bones, cartilage, fat or muscle of the treated limb. Use in children, patients over age 65, or in joints other than the knee has not yet been assessed.
The occurrence of subsequent surgical procedures (SSPs), primarily arthroscopy, following CARTICEL implantation is common. In the Study of the Treatment of Articular Repair (STAR), forty-nine percent (49%) of patients underwent an SSP on the treated knee, irrespective of their relationship to CARTICEL, during the 4-year follow up. The most common serious adverse events (≥5% of patients), derived from STAR, include arthrofibrosis/joint adhesions, graft overgrowth, chondromalacia or chondrosis, cartilage injury, graft complication, meniscal lesion, graft delamination, and osteoarthritis.
For more information on CARTICEL, please see the Package Insert (PDF).