Treating Damaged Cartilage

There are several options for regeneration and/or repair of damaged articular cartilage. Your doctor will determine which option is right for you based on the type and extent of your knee injury. It is important to note that early intervention may help to prevent further deterioration to the joint surface.

Meniscal Repair

Preserving or Restoring the Meniscus

Typically, the first line of surgical treatment is an attempt at repair. Historically, in the days of open cartilage surgery, the entire meniscus was removed. With the advent of arthroscopy, standard treatment evolved to remove only the damaged area. Today, many cartilage surgeons believe there is value in protecting the meniscal cartilage and make every attempt to conserve this tissue.

Replacing the Meniscus

For patients who have had the meniscus removed, the surgeon may offer an innovative solution called a meniscal transplant. It is important to remember that even though only a part of the meniscus was removed, at times, the effect to the knee from a biomechanical standpoint is the same as a total menisectomy. Unlike other forms of tissue transplantation, this procedure does not require patients to be on medications to prevent rejection.

Articular Cartilage Repair

There are various surgical treatment options to address articular cartilage loss, ranging from pain relief to cartilage replacement. Several of the most common treatments are described below.

Arthroscopic Chondroplasty (Debridement)

Using an arthroscopic approach, surgeons locate the damaged chondral tissue and trim away or stabilize the area. This prevents flaking off of the damaged tissue which often irritates the lining of the joint and leads to swelling. This “clean up” surgery of the joint surface is called a chondroplasty. Chondroplasty may relieve pain for a short period of time, but it does not repair the cartilage defect.

Marrow Stimulation Repairs (Microfracture)

In some cases, the body can be stimulated to produce its own repair tissue through an arthroscopic procedure called microfracture. This procedure is an attempt to repair a small cartilage defect using the body’s own marrow stem cells.

This repair tissue develops from cells brought to the area with blood deep in the bone underneath the cartilage. These cells enter through small holes made through the bone by abrasion, drilling, or using a small pic to create microfractures. Think of this as repairing a pothole in the road. Filling in the hole prevents it from widening and involving the entire road. These techniques may be successful in addressing symptoms in some patients.

Osteochondral Autograft

This technique is analogous to a hair-plug transfer. The surgeon removes a small section of the patient’s own cartilage along with the underlying bone plug. This is obtained from an area that does not bear a lot of weight. The size of the defect treatable with this method is usually between 1 and 2 cm² or slightly larger than a thumbnail.

Autologous Cartilage Cell Implantation

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 surgical repair procedure. To learn more about CARTICEL, please see our How CARTICEL Can Help page.

Allografts

For very large defects that involve bone and cartilage loss, surgeons may use an implant obtained from freshly donated cadaver cartilage and bone. The advantage of donated cartilage and bone is that the implant includes both bone and fully developed cartilage for the repair. There may be some risk of infection from the donor tissue using this procedure.