Recent advances in cartilage repair and regeneration | HSS (2023)

Articularcartilage can be damaged by traumatic injury, progressive wear, or systemic disease. Loss or erosion of articular cartilage causes pain, weakness, and dysfunction. If not treated,cartilage damageit can progress and lead to symptomatic arthritis.

Cartilage has little ability to repair itself. As a result, people who have joint dysfunction (knee, ankle, hip, elbow) associated with painful cartilage or chondral injury may require surgery. Successful cartilage repair surgery reduces pain and restores function. There are numerous cartilage repair treatment options available, and the suitability of each of these approaches depends on each patient's unique clinical problem. doctors ofHSS Institute for Cartilage Repairwe are specialists in the treatment of damaged articular cartilage. Their clinical approaches are data-driven, and as a result, our physicians experience high clinical success rates in their respective patient populations.

What is cartilage repair/regeneration?

In its simplest terms, cartilage repair (regeneration) surgery results in the formation of robust cartilage-like tissue around the joint where the cartilage has been worn away or damaged. Cartilage regeneration usually requires some type of surgical intervention. Synthetic adjuncts are often required to successfully regenerate articular cartilage. Adults do not have the natural ability to grow new articular cartilage from scratch. This ability is only possible in a fetus growing inside the womb. This fact makes cartilage repair surgery challenging.

How is cartilage damage diagnosed?

Our doctors will take a complete medical history, perform a physical exam, and use imaging studies (X-rays, MRI, CT scan) to determine the location and extent of articular cartilage damage. Advanced MRI technology allows surgeons to create a personalized treatment plan prior to surgery. Continuous MRI readings taken after surgery allow for an objective evaluation of the surgery performed and the application of an appropriate rehabilitation plan that together facilitate a full recovery.

Can cartilage heal on its own?

No. Articular cartilage is the soft cushion that lines the ends of bones where they meet in joints like the knee, shoulder, and ankle. Intact articular cartilage allows bones to move against each other without friction in healthy joints. Cartilage does not contain nerves and does not have a complete blood supply. As such, cartilage does not have the ability to heal on its own.

Can damaged cartilage be repaired?

Damaged existing cartilage cannot usually be repaired. However, there are treatment options in which damaged articular cartilage can be replaced or rebuilt using cell-based or tissue-based strategies.

For example, one commonly performed procedure (mosaicoplasty, osteochondral autograft transplantation) works by taking small cylinders of cartilage from an area of ​​a patient's joint (usually a non-weight-bearing area) to reconstruct and fill a cartilage defect in an area Weight-bearing Another frequently performed procedure uses donated cartilage tissue (osteochondral allograft) to reconstruct large articular cartilage lesions. In yet another method, small arthroscopically removed samples of cartilage can be used to grow a custom "patch" of cartilage that can be used to fill in a cartilage defect. HSS surgeons have been performing these procedures since the 1990s and have been at the forefront of the development of all of these described methodologies.

What is cartilage repair surgery?

Cartilage repair surgery consists of regenerating or replacing cartilage, either with tissue from the patient's own body, from another person's body, or by generating cartilage repair tissue in the laboratory.

Who is a good candidate for cartilage repair?

The ideal candidate for cartilage repair is someone suffering from an isolated articular cartilage defect. The patient should have a relatively healthy knee without widespread cartilage loss (arthritis). The treated knee should be well aligned and stable (no ligament deficiencies). Cartilage repair can be performed on people of all ages, but patients are typically under the age of 50.

What conditions can be treated with cartilage repair?

Cartilage injuries that can be treated with cartilage repair surgery include:

• articular cartilage defects
• chondral defects
• chondral lesions
• osteochondral defects
• costochondritis dissecans lesions
• osteochondritis dissecans (OCD)
• necrosis avascular(AVN), also known as osteonecrosis

What parts of the body can be treated with cartilage repair?

Cartilage repair is most commonly used to treat isolated cartilage defects. Cartilage repair surgery is not performed to treatarthritis. However, cartilage repair surgery can help affected individuals delay or avoid aknee replacement. Cartilage repair can also be used to treat cartilage injuries of the ankle, elbow, shoulder, or hip.

What are the types of procedures for cartilage repair?

Due to recent medical advances, there are now several treatment options available, depending on factors such as the size of the cartilage damage and the patient's end goals.

• Debridement or chondroplasty –The purpose of this procedure is to relieve symptoms associated with mechanical blockages of movement associated with cartilage injuries. The surgeon will remove the loose pieces of cartilage that cause joint pain and often send them to the lab for a cell-based procedure (MACI) later (see below). It may also be beneficial to inject an adjunctive treatment, such as a bone marrow aspirate concentrate. This is a concentration of the patient's own bone marrow cells, which aid in healing. Sometimes a bridging procedure like this is appropriate if the patient is an experienced athlete.
• microfracture surgery–This arthroscopic bone marrow stimulation procedure involves creating small holes at the base of the cartilage lesion to promote a healing response and create cartilage repair tissue. This is used to treat small areas of cartilage damage and can be effective for short-term treatment of cartilage defects in the knee, while newer techniques are better for people looking for a long-term, durable solution.
• Full fabric options –
  • Osteochondral autologous transplant surgery(AVENA) -Surgeons take articular cartilage from a healthy, weightless area of ​​the patient's knee and transplant it into the damaged area of ​​articular cartilage. The use of the patient's own tissue facilitates a highly durable repair and excellent clinical results. This method has shown good results in individuals who participate in high-demand activities. This procedure is also known as autologous osteochondral transfer (AOT).
  • Osteochondral allograft transplantation –Surgeons use whole tissue specimens from donors to treat large lesions. This method is best for large lesions and lesions that also involve large segments of bone (osteochondritis dissecans, avascular necrosis). Osteochondral allograft surgery can also be performed as a salvage procedure for other failed cartilage repair surgeries. Cartilage allograft surgery may not be as durable in the long term in people with high demand
• Matrix-induced autologous chondrocyte implantation(MACI)-Autologous chondrocyte implantation has a long history of clinical success and is one of the most common techniques used today to repair knee cartilage. In this procedure, surgeons remove a small sample of healthy cartilage from the knee in a small operation. Cells are isolated, cultured in the laboratory, and seeded on a collagen patch. In surgery, the patch is shaped and glued to the cartilage defect. This patch eventually becomes healthy new cartilage repair tissue. Research has shown this to be very effective for injuries to the femur (thigh bone), patella (kneecap), and tibia (shin bone).
• Particulate Juvenile Articular Cartilage Allograft Transplantation –This procedure uses small fragments of donated cartilage tissue to facilitate the formation of cartilage repair tissue. Unlike osteochondral allografts, this method does not have bone associated with cartilage. The surgeon transplants small pieces of donated cartilage into the damaged area and secures the transplant with fibrin glue. The transplanted cartilage grows rapidly into durable cartilage repair tissue. Studies outside of the HSS have demonstrated the clinical efficacy of this method in high-demand individuals.

How long does cartilage repair surgery take?

Most of the described surgical procedures take less than an hour. Surgeries can be done arthroscopically, but may require a small incision to fully perform the procedure. Combining the cartilage repair procedure with other surgeries (ligament reconstruction, osteotomy) can prolong the procedure accordingly.

How long does it take to recover from cartilage repair surgery?

Most patients use crutches for the first two to three weeks after surgery. Physical therapy usually begins about a week after surgery on an outpatient basis. Most patients can return to their normal activities of daily living four to six weeks after surgery. Many patients are discharged for some sports after six months. However, returning to a high level of fitness or ballistic sports may take longer. Different surgical treatment options have different time frames for returning to high-level activities. Osteochondral autograft and allograft patients can generally expect release within six months. In contrast, the MACI procedure, because this method requires two surgeries six to eight weeks apart, the total recovery time is closer to 12 to 18 months.

Physiotherapyit is an important part of recovery and should be used as appropriate. Postoperative MRIs are used to assess the success of the procedure and show progress during the physical therapy process.

How long before I can return to exercise after cartilage repair?

If you want to return to heavy lifting or athletics, it's important to work with a strength and conditioning coach to help you with your training.

What is the success rate for cartilage repair?

As a subspecialty, cartilage repair surgery has evolved rapidly since its inception in the late 1990s. Prior to that time, few treatment options were available to address this clinical problem. Currently, there are several ways to treat cartilage damage. Success rates really depend on many factors (surgery performed, age of patient, body mass index, duration of symptoms, etc.). Our surgeons have been tracking their clinical outcomes in this area since 1998. The HSS Cartilage Registry has been tracking the clinical outcomes of more than 4,000 patients who have been treated for symptomatic cartilage defects. Our surgeons recommend personalized treatment options based on objective data and clinical results.

What are the potential risks of cartilage repair?

There is no more risk involved than the typical surgical risk.

Can cartilage be repaired without surgery?

Just no. In most cases, surgery is needed to repair the articular cartilage.

In rare cases, minor traumatic cartilage injuries form a repair tissue called fibrocartilage on its own. This usually occurs at the time of the injury if there has been a significant amount of bleeding and trauma. Fibrocartilage is found between the vertebrae of the spine, in the meniscus of the knee, and in the joint capsules that surround some joints. Fibrocartilage is inferior to articular cartilage for load-bearing purposes in a joint.

What vitamins or supplements help repair cartilage?

Taking vitamins does not help cartilage repair itself. However, there are supplements that may play a role in controlling and limiting joint inflammation associated with cartilage damage. Oral supplements such as glucosamine sulfate or hyaluronic acid may be helpful in relieving symptoms. None of these substances have been clinically proven to promote or result in the repair of damaged cartilage. Our recommendation is that it is best to consult your doctor before adding any supplement to your diet.

Learn more about individual cartilage repair surgical procedures and related conditions and treatments in the content below.

Updated: 02/15/2022