Cartilage injuries typically refer to the articular cartilage of the knee, which is the soft, protective layer covering the bone of the femur (thigh bone) and tibia (leg bone). It is similar to the “gristle” at the end of a chicken bone. It’s purpose is to help cushion the knee joint. When it become thinned or injured, there is more contact between the bones, leading to pain and arthritis. Focal defects in the cartilage, compatible with “potholes”, can often be treated surgically. There are several options, which will be discussed in more detail in separate threads:
1. Microfracture- drilling multiple holes in the defect to prompt filling in of fibrocartilage; good for smaller defects
2. Osteochondral transfer (OATS) – taking a plug of bone and cartilage from one part of the knee, and transferring it into the defect; good for small or medium defects
3. Allograft OATS – for larger defects, cadaver bone and cartilage can be used instead of your own tissue
4. Autologous Chondrocyte Implantation (ACI) – a staged procedure, where normal cartilage cells are harvested from the knee, then grown in a lab to “clone” them into a cluster of new cells to be implanted into the defect; good for large defects
5. DeNovo NT Graft – the newest technique, where juvenile cartilage cells from a cadaver are implanted to the defect, and held in place with a fibrin glue; good for medium or large defects
All of the above techniques have strengths and weaknesses, and are not indicated for every defect. None of the procedures works for treatment of cartilage damage due to generalized arthritis. An MRI is the best study to look at the size and depth of the defect, to determine if repair is a possible option. Once that has been determined, a discussion can be made to determine which treatment option is best for you.
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