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w w w . s t h e l e n a h o s p i t a l c l e a r l a k e . o r g | 9

Cartilage repair and regeneration is treatment for an otherwise

healthy knee, but not for knees affected by osteoarthritis, a

condition that causes natural cartilage deterioration from aging.

Who is eligible?

The treatment is recommended for patients with knee cartilage

damage or deterioration caused by:

Injury or trauma, including sports injuries.

Repetitive use of the joint.

Congenital abnormalities, meaning those that a

person is born with, affecting normal joint structure.

Hormonal disorders that affect bone and

joint development, such as osteochondritis

dissecans (OCD).

Microfracture/drilling.

The goal of microfracture is to

stimulate the growth of new articular cartilage by creating a new

blood supply. A sharp tool, called an awl, or a high-speed drill is

used to make multiple holes in the joint's surface. The holes are

made in the bone beneath the cartilage, called subchondral bone.

This action creates a healing response. A new blood supply can

reach the joint surface, bringing with it new cells that will form

the new cartilage.

Abrasion arthroplasty.

Abrasion arthroplasty is similar to

drilling. Instead of drills or wires, high-speed burrs are used to

remove the damaged cartilage and reach the subchondral bone.

Autologous chondrocyte implantation (ACI).

ACI is a two-step procedure. New cartilage cells are grown

and then implanted.

First, an arthroscopic surgery is performed and a small amount of

healthy cartilage tissue is harvested. The tissue, which contains

healthy cartilage cells, or chondrocytes, is then sent to the

laboratory. The cells are cultured and increased in number over

a three to five week period.

A surgical procedure, or arthrotomy, is then performed

to implant the newly grown cells.

ACI is most useful for younger patients who have single defects

larger than 2 centimeters in diameter. ACI has the advantage

of using the patient’s own cells; however, it does have the

disadvantage of being a two-stage procedure.

Types of Cartilage Restoration Procedures

Osteochondral autograft transplantation.

In this

procedure, cartilage is transferred from one part of the joint to

another. Healthy cartilage tissue — a graft — is taken from an

area of the bone that does not carry weight (non-weight-bearing).

The graft is then matched to the surface area of the defect and

then impacted into place. This leaves a smooth cartilage surface

in the joint.

Osteochondral allograft transplantation.

If a cartilage defect is too large for an autograft, an allograft may

be considered. An allograft is a tissue graft taken from a deceased

donor. Like an autograft, it is a block of cartilage and bone. In the

laboratory, it is sterilized, prepared and tested.

These are just a few of many techniques available today. There is

vast research being done on new techniques which will continue to

change the way we think and treat cartilage injuries.

Once upon a time, people with joint pain

resulting from cartilage damage just had to grin

and bear it. Today, advances in research and

technology have made the repair, regeneration,

and replacement of cartilage possible for

athletes and others with debilitating joint

cartilage damage…sometimes with such

success that there is no need to use artificial

joints to restore mobility.

To learn more about

new advances in cartilage

restoration, contact

Brian Freeto, MD,

at 707.995.4508.

Brian Freeto, MD