Articular cartilage is the white tissue lining the end of bones where these bones connect to form joints. Cartilage acts as cushioning material and helps in the smooth gliding of bones during movement. An injury to the joint may damage this cartilage, which cannot repair on its own.
Cartilage can be damaged with increasing age, normal wear and tear, or trauma, which can no longer cushion the joints during movement. The joints may rub over each other causing severe pain and inflammation.
What is Cartilage Restoration?
Cartilage restoration is a surgical procedure where orthopedic surgeons stimulate new cartilage growth that restores the normal function. Arthritis condition can be delayed or prevented through this procedure.
Techniques Involved in Cartilage Restoration
Several techniques are available for cartilage restoration, including:
- Dietary supplements: Dietary supplements such as glucosamine and chondroitin are the non-surgical treatment options for cartilage restoration. Chrondroitin sulfate and glucosamine are naturally occurring substances in the body that prevent degradation and promote new cartilage formation. Chrondroitin sulfate and glucosamine obtained from animal sources are available over the counter products and are recommended for cartilage restoration.Apart from these, various other nutritional supplements are recommended, such as calcium with magnesium and vitamin D as a combination, S-adenosyl-methionine and methylsulfonylmethane.
- Microfracture: In this method, numerous holes are created in the injured joint surface using a sharp tool. This procedure stimulates a healing response by creating a new blood supply. Blood supply results in the growth of new cartilage.
- Drilling: In this method, a drilling instrument creates holes in the injured joint surface. Drilling holes create blood supply and stimulate the growth of new cartilage. Although the process is like microfracture, it is less precise and the heat produced during drilling may damage other tissues.
- Abrasion Arthroplasty: High-speed metal-like object removes damaged cartilage. This procedure uses an arthroscope.
- Osteochondral Autograft Transplantation: Healthy cartilage tissue (graft) is taken from the bone that bears less weight and is transferred to the injured joint. This method is used for smaller cartilage defects.
- Osteochondral Allograft Transplantation: A cartilage tissue (graft) is taken from a donor and transplanted to the injury site. Allograft technique is recommended if a larger part of cartilage is damaged.
- Autologous Chondrocyte implantation: In this method, a piece of healthy cartilage from another site is removed using an arthroscopic technique and is cultured in a laboratory. Cultured cells form a larger patch, which is then implanted in the damaged part by open surgery.
- Osteoarticular Transfer System (OATS): Osteoarticular transfer system (OATS) is a surgical procedure to treat isolated cartilage defects, which are 10 to 20mm in size. The procedure involves transferring cartilage plugs taken from the non-weight-bearing areas of the joint and transferring into the joint’s damaged areas.
- This procedure is not indicated for widespread damage of cartilage as seen in osteoarthritis.
Cartilage Restoration Procedure
The procedure is performed using arthroscopy. During the procedure, the plugs taken are usually larger. Therefore only one or two plugs are needed to fill the area of cartilage damage. The damaged cartilage area is prepared using a coring tool that makes a perfectly round hole in the damaged bone.
The hole is drilled to a size that fits the plug. Next, the plug of normal cartilage is harvested from a non-weight-bearing area of the knee, then implanted into the hole created in the damaged area. The size of the plug used should be slightly larger than the hole to fit into the position. This procedure allows the newly implanted bone and cartilage to grow in the defective area.
Post-surgical Care for Cartilage Restoration
Following OATS, rehabilitation is recommended by the use of crutches and limiting the range of motion.
Risks and Complications of Cartilage Restoration
Possible complications of OATS include donor site morbidity causing pain, avascular necrosis and fracture. Other complications such as hemarthrosis, effusion and pain may also occur.