Healthy cartilage helps one bone smoothly glide over another without friction during normal movements. The type of cartilage often affected by age-related wear and tear or injury is the articular cartilage found at the ends of bones. While this firm, flexible connective tissue is fairly durable, it does not heal well. Damaged cartilage around joints is especially problematic because it can increase stress on joints and inflame or irritate nearby tissues. If other treatment attempts fail, cartilage restoration surgery may be recommended.
Who May Benefit from Cartilage Restoration?
A patient’s overall health and the extent of the damage to the cartilage and the nearby joint will determine eligibility for cartilage restoration surgery. Younger patients with damage relegated to a single area may respond better to this type of surgery better than older patients with cartilage damage affecting multiple joints, as may be the case when arthritis contributes to joint and tissue damage. Cartilage restoration is often done on knees, although it may also be performed on hands, shoulders, ankles, and other joints affected by cartilage damage.
How is Cartilage Restoration Surgery Performed?
Many cartilage restoration procedures performed today use less-invasive arthroscopic techniques to minimize damage to surrounding tissues. If damage to the joint includes ligament or tendon tears that will also need to be corrected, open surgery may be necessary to provide better access to the affected area.
What Specific Procedures May Be Recommended?
There are several procedures that may be done to restore damaged cartilage. Microfracture is a type of surgery done to stimulate the growth of new cartilage around a joint. Multiple holes are made in the bone beneath the cartilage (subchondral bone) to increase blood supply to the area and attract cells that will facilitate tissue regeneration. Drilling is a similar technique that also stimulates cartilage regrowth.
With abrasion arthroplasty, high-speed burrs are used to remove cartilage that’s damaged. Autologous chondrocyte implantation (ACI) is a two-step cartilage restoration procedure. Healthy cartilage is first taken from a bone that does not support any weight. Cells are cultured over a 3-5-week period before being injected under bone-lining tissue (periosteum) placed over the treated area.
Osteochondral autograft transplantation is the transfer of healthy cartilage tissue from one area to another. Cartilage plugs are then inserted into the area with the defective or damaged tissue. Osteochondral allograft transplantation uses tissue from a cadaver donor. Scientists are currently researching the possibility of using stem cell therapy to facilitate cartilage restoration.
After cartilage restoration surgery, mobility in the affected area will need to be limited to allow tissues to heal. If cartilage around the knee joint was restored, for example, crutches are typically used to keep weight off the area. Physical therapy usually involves techniques that gradually increase range of motion and flexibility. As recovery advances, exercises will be added to improve joint and muscle strengthen where the cartilage was restored to allow the patient to safely return to normal activities.