How is a cartilage defect repaired?
It is important to assess the exact location of the focal articular cartilage defect and what the underlying causes are. Articular cartilage changes on the lower portion of the femur (where the patella rests) are generally, easier to treat than the area where the femur and tibia meet. The size of articular cartilage legions is also an important treatment factor.
Not all focal articular cartilage defects require surgery. Dr. Vidal prefers a conservative approach which includes observation, RICE (rest, ice, compression, elevation), bracing, physical therapy and biologic treatments (PRP and Stem Cell).
Due to the highly technical and individualized nature of focal articular cartilage defect repair, it is important to seek the advice of Dr. Vidal who has had extensive, successful experience in treating cartilage defects, tears and damage.
There is not a “one size fits all” treatment when it comes to a cartilage repair. Dr. Vidal will consider several different factors including the size and location of the defect, as well as the overall status of the joint. He will also discuss the current symptoms, long term goals of the patient, and their willingness to commit to the necessary postoperative rehabilitation. Some of the treatments Dr. Vidal may use include:
- Chondroplasty – Dr. Vidal debrides (trims away) the damaged area of cartilage. This treatment smooths out the area and helps to reduce pain, swelling and mechanical symptoms. Frequently, chondroplasty serves as the first step in a more complicated cartilage treatment.
- Augmented Microfracture – This treatment is best described by comparing it to road treatment for potholes. Used when the cartilage damage in the knee appears to be gouged out or have a divot, microfracture surgery fills in the “pothole”
- Allograft (OATs) – Osteochondral allograft transfer (often referred to as allograft OATs) is often called the “gold standard” for cartilage repair. In an allograft OATs procedure, a plug of living, viable cartilage and bone is harvested from a donor to repair a focal chondral lesion. The donor tissue is size-matched to an individual patient and surgically prepared to precisely reconstruct a lesion.
- Matrix Associated Chondrocyte Implantation (MACI) – is a two-stage procedure where a biopsy of healthy cartilage is first removed from the knee (during the chondroplasty step) and cultured in a specialized lab in Boston. These cultured autologous (your own) chondrocytes are then embedded on a specialized collagen membrane and used to patch an area of cartilage damage.
(For more information and detail on these surgical treatments, please click on the procedure listed.)