3Articular cartilage is the cartilage on the end of bones where they articulate in a joint. It could be compared to the Teflon coating on a non-stick pan. It creates a smooth surface, but once it is damaged the joint cannot function like it should leading to swelling and pain. So what is the treatment? Well, for select individuals that have a small localized area where the cartilage is damaged or missing that is surrounded by healthy cartilage, cartilage regeneration/repair may be an option. These procedures (discussed below) have been found to be less effective in individuals with diffuse arthritis. Since arthritis is a degenerative process, the body will usually proceed to breakdown any cartilage repair just like it did to it’s own natural cartilage.
Types of cartilage regeneration/repair procedures:
- For this procedure, the damaged cartilage is removed until there is exposed bone. Then, multiple small holes are punctured into the bone to stimulate healing. Positives: easy to perform and can be done arthroscopically (through tiny incisions). Negatives: there is no guarantee the body will produce cartilage in that area and when it does, it is not as good of quality as the original articular cartilage.
- Osteochondral autograft transfer system (OATS)
- This procedure requires taking healthy articular cartilage with attached bone (a bone plug) from a non-weight bearing surface and implanting it in the cartilage defect. Positives: it is using the patients own articular cartilage. Negatives: this is an open procedure (requires a larger incision), and there must be healthy cartilage elsewhere in the knee to obtain the plug.
- Autologous chondrocyte implantation (ACI) (Carticel)
- For this procedure, the patient’s own cartilage is biopsied and sent to a lab. The lab grows more cartilage from the sample. This cartilage can then be implanted back in the patient in the cartilage defect. Positives: it is the patient’s own cartilage. Negatives: this is a two stage (two surgery) procedure. The first surgery is for the biopsy and the second surgery is for re-implantation of the cartilage.
- Allograft cartilage (Biocartilage, Cartiform)
- This is donor cartilage in the form of a paste or a patch. The paste is placed in the cartilage defect and secured with glue. The patch is sown into the cartilage defect using the surrounding healthy tissue. Positives: there is no biopsy or harvesting of the patient’s cartilage. Negatives: these are open procedures, and there has to be surrounding healthy tissue.
The type of cartilage regeneration procedure used depends on a lot of factors and should be decided by a medical professional. Some of the factors include: the size of the cartilage defect, if it’s surrounded by healthy articular cartilage, and whether it’s on a weight bearing surface or not. These factors can be analyzed on an MRI.
Hopefully this helped shed some light on cartilage regeneration procedures. The bottom line that that there needs to be an isolated cartilage defect surrounded by healthy cartilage for optimal results.