What is knee cartilage repair or restoration?
Cartilage repair or restoration refers to the techniques used to restore or replace cartilage to an area that is damaged. These techniques can take many forms:
Chondroplasty: Chondroplasty is the simplest of the surgical cartilage treatment options. Although not technically a “repair”, chondroplasty serves a very important role in the treatment pathway for cartilage injuries. During this arthroscopic procedure, 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. This procedure serves a very important diagnostic and therapeutic role. In some cases, this is all that is needed to achieve the desired outcome. In others, it allows Dr. Vidal to better assess the lesion, the context in which it occurs, stage its severity and size, and help formalize a personalized treatment strategy. Additionally, during this procedure cells can be harvested for a MACI procedure if that is determined to be the right option for your lesion (see below).
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.” This is done by Dr. Vidal making small holes in the defective area’s bony surface, causing it to “bleed.” The bone sends out marrow and stem cells to form a clot over the defective area as a response to heal the small microfractures. The result is a covering of fibrocartilage which fills in the damaged areas of the cartilage. Modern modifications of this technique enhance the biology and the quality of the repair tissue by using scaffolds that encourage the marrow and stem cells to differentiate into cartilage cells (chondrocytes) rather than scar tissue.
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. This technique is very versatile and can allow for reconstruction of large and irregular lesions. The greatest benefit of this technique is that it is a true hyaline cartilage repair strategy that is actual cartilage from day one! Think of the difference between laying sod and planting seeds for an area on your lawn that is missing grass. Keep in mind, however that despite its versatility, it may or may not be the best option for your lesion.
Matrix Associated Chondrocyte Implantation (MACI): 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. This technique is also very versatile and allows for the repair of even very large lesions with your own cells. Dr. Vidal has extensive and successful experience with MACI, whereas very few other surgeons have experience with this technique or perform it with much frequency. It is important to ask your provider about their personal experience with MACI, especially in the Vail, Aspen and surrounding Denver Colorado communities.
Novel Procedures: Cartilage repair and restoration is still in its infancy compared to many other orthopedic procedures. There are several novel techniques that are being developed. Dr. Vidal is committed to innovation and advancing the science of cartilage repair. As such, he is involved in several FDA trials looking at novel scaffolds that may hold the future of repair of these lesions. Feel free to ask Dr. Vidal at your consultation if you may be a candidate for enrollment in one of these trials.