Cartilage Restoration in Kirkland, WA
Cartilage is a type of specialized connective tissue. There are three main types of cartilage. Articular cartilage provides a smooth, white layer covering the femur, tibia, and undersurface of the patella. The main functions of this cartilage is to provide shock-absorbing properties and allow for a frictionless smooth surface. Articular cartilage lacks blood supply and therefore has a limited capacity for healing. It can be injured by trauma or repetitive injury.
Cartilage injuries may cause pain, swelling, and/or locking if the fragment has separated into the joint. The surgical treatment options for cartilage damage are: debridement (cleanup), microfracture, cartilage (osteochondral) transplant, allograft, and chondrocyte transplantation. These cartilage restoration procedures can be done using minimally invasive arthroscopic techniques.
The microfracture technique is used for small full-thickness cartilage defects with exposed bone. In this surgery, small holes are placed in the bone which allows the release of blood and bone marrow contents into the cartilage defect. This activates a healing response and stimulates the production of the fibrocartilage layer, which forms over the exposed bone. This does not form normal joint cartilage, but a scar cartilage. This technique is helpful in most patients with small cartilage lesions.
Osteochondral Transplant (OATS)
Osteochondral (cartilage) transplantation (OATS) procedures are designed for full-thickness cartilage defects. This surgery involves removing the area of damaged cartilage along with a cylindrical piece of bone underneath. A matching size piece of bone and cartilage can then be removed from an area of the patient’s knee where it is not load bearing. In the case of large areas, an allograft (cadaver) bone and cartilage can be used.
The typical patient considered for this procedure is a young, active individual with a traumatic isolated chondral injury. The advantage of this procedure is that it allows placement of hyaline (articular) cartilage into the chondral defect. This technique is performed through a minimally invasive arthroscopic procedure, or through an open technique depending on the size and location of the lesion.
Chondrocyte transplantation is used for relatively large cartilage defects in the knee, where the underlying bone is normal. This procedure is usually done in one of two ways. Cartilage cells can be harvested from the patient, sent to a lab, grown, and then later implanted into the patient via a second surgery. The other option is to use pre-grown chondrocyte cells, which requires only one surgery. In either case, the lesion is cleaned of any residual cartilage. A tissue patch with cartilage cells in it is then glued into the lesion. These cells then grow into hyaline (articular) cartilage.