What is cartilage restoration and transplant?
Cartilage is the lining surface of all our joints. It is a complex material that allows for smooth, near-frictionless motion. However, cartilage cells, or chondrocytes, are extremely vulnerable to injury, and have little to no ability to heal after injury. Cartilage restoration and transplant procedures are aimed at treating cartilage injuries in patients who have sustained joint injuries in the absence of arthritis.
What kind of cartilage injury can be treated with restoration or transplant?
The ideal candidate for a cartilage restoration procedure is an individual with normal (or near normal) joint cartilage surfaces, who has a single, isolated area of cartilage damage. This is usually seen after an injury where the joint was twisted or dislocated, knocking off a “pothole” of cartilage in the process. Another situation that can cause isolated cartilage lesions is Osteochondritis Dessicans (OCD). In OCD, a small portion of the bone under the cartilage in a joint looses its blood supply, causing the overlying cartilage to soften and sometimes dislodge. In rare cases, patients with isolated Avascular Necrosis (AVN) might benefit from a cartilage restoration procedure. Widespread cartilage injury and arthritis cannot currently be treated with restoration procedures.
What about Platelet-Rich Plasma (PRP), Bone-Marrow Aspirate Concentrate (BMAC), and stem-cell treatments?
Recent studies have suggested a short-term benefit of PRP, BMAC, and stem-cell procedures in terms of pain and function for patients with both widespread osteoarthritis, as well as localized cartilage damage. Long-term benefits and actual restoration of the damaged cartilage lining has not been consistently demonstrated to date.
How is a cartilage transplant or restoration procedure performed?
Most surgical cartilage restoration procedures involve replacement of the damaged area of cartilage with either cartilage cells or actual cartilage “plugs” that can fit into the damaged area like a puzzle piece. The one exception to this rule is with microfracture, which involves drilling multiple small holes in the bone exposed by the cartilage injury. This releases the underlying stem cells that form a new cartilage layer that is similar to, but not the same as the original cartilage. For cartilage transplants, the cartilage can be an autograft (your own cells or “plug”), or an allograft (a “plug” from a deceased donor, like a tissue or organ donation). Depending on the type and size of the cartilage defect, different approaches can be used.
How effective is a cartilage transplant procedure?
This depends on the location, type, and size of the injury. In general, when done in the perfect setting, some studies have shown good and excellent results and survival of transplanted tissue (specifically allograft cartilage “plugs”, also known as allograft OATS (Osteochondral Allograft/Autograft Transfer Surgery) of up to 20 years. Again, these results are in the best of circumstances, and the goal of a cartilage restoration procedure, at this point in time, is to allow for a continued active lifestyle with the hopes of delaying the onset of degenerative arthritis.
How do I know if a cartilage transplant or restoration procedure is right for me?
Most cartilage lesions are diagnosed on MRI, or after a diagnostic arthroscopy. We do ask that all patients have comprehensive plain xrays of the joint involved. Consultation with a medical provider experienced in the evaluation of cartilage injuries and their treatment will provide you with the best source of information and counseling to education you on the best course of action. Multiple opinions are also helpful because of the continual evolution and improvements in care for cartilage injuries.
For more information, please visit the following link:
AAOS Articular Cartilage Restoration