Cartilage Restoration Procedures

That tough, resilient tissue covering the ends of your knee bones allows your joints to glide smoothly and cushions the shock during high impact activities. Articular cartilage does not appear to be alive, but in fact, it is. Cells called chondrocytes live inside the cartilage matrix suspended in much the way marshmallows might be suspended in Jell-O. These cells only constitute 1 to 5% of articular cartilage but they have a critical role: keeping the complex matrix made of large molecules and collagen healthy.

As the cartilage wears out, the chondrocytes repair it — in small quantities. Butchondrocytes do not replicate. So once damaged or lost, these cells cannot repair the matrix and the cartilage matrix degenerates without some help. Our surgeons at The Cartilage Restoration Center of New Jersey can provide the help cartilage needs to start a healing response.

Early Intervention

In light of our discussion, you can understand the importance of early intervention to prevent knee joint degeneration and arthritis. The CRCNJ provides several options for repair and/or regeneration.

Surgeons locate the damaged articular cartilage tissue through 1/4 incharthroscopy incisions and stabilize the area with trimming. This prevents the damaged tissue from flaking off resulting in joint irritation, swelling, and pain. We call this cleanup procedure a chondroplasty. Injuries smaller than 3/8 inch, or so, probably will not progress to further damage if nothing else is wrong with the knee. (What are some other “wrong things?” Some examples include loss of meniscal tissue, bow legs, or knock knees.)

In order to keep the lesion small and well defined, we can stimulate the body to produce repair tissue by bringing some blood from the underlying bone to create some “scar” tissue. The surgeon uses a pick, drill or burr to create a microfracture. The tissue your body produces from this technique, fibrocartilage and not the more robust hyaline cartilage, keeps the small damage from spreading to the surrounding area much the way one would repair a pothole in the road to keep the rest of the road from damage. These pothole repairs will not last as long as a normal road but they do eliminate symptoms in many patients and may delay the progression to further degeneration.

Analogous to a hair-plug transfer, the surgeon removes a small plug of your own cartilage along with some underlying attached bone. The plug comes from an area of your knee that does not carry much load. He then drills a receiving hole in the damaged cartilage area and transfers this bone and cartilage plug to that site. This plug is osteochondral, derived from “osteo” for bone and “chondral” for cartilage; this plug is also an autograft since the graft comes from your own body.

Of course, the knee has limited tissue available for transplantation. Typically we take the transplant plugs from the edge of the trochlea where the patella glides. But if that area is damaged this technique may not be possible. These defects can be repaired in an area up to about the size of your thumbnail but not generally larger.

This technique is similar to that of osteochondral autograft transfer, but it involves taking a larger amount of tissue from a cadaver rather than from the patient’s own knee. This procedure is an excellent option for larger defects. It also can be successfully used to correct a previously failed cartilage repair surgery. Freshly obtained grafting material, as opposed to frozen or freeze-dried specimens, is used to help ensure the best outcome. Ideally, the graft material is taken from the same location as the patient’s defect and is roughly the same size.

To perform this procedure, the surgeon makes an open incision and identifies the defect. Once the size has been determined, the surgeon removes the abnormal cartilage and a small amount of bone, creating a tunnel. Then, the fresh donor material is obtained. The surgeon attempts to obtain donor material that matches the size and shape of the patient’s tunnel. The donor material is then inserted in the tunnel.

MACI is a procedure that repairs cartilage using the patient’s own cells. MACI provides long-lasting pain relief and improvement in function.

How does MACI Work?

A sample of your cartilage cells (chondrocytes) is sent to a laboratory and embedded on a special collagen membrane which your doctor then implants into your knee. The cartilage cells regenerate, forming a repair tissue that is able to fill the cartilage defect.

MACI has been proven to provide three important things:

A Functional Repair Tissue

MACI produces a type of repair tissue that alleviates symptoms and restores joint function which has been shown to form as early as 5 months after the MACI procedure.

Reduced Pain and Improved Function

In the SUMMIT clinical trial, MACI has been shown to offer greater pain relief and improvement in function when compared to microfracture.

Patient Satisfaction

In the SUMMIt clinical trial, MACI patients reported a higher quality of life score, a greater ability to perform recreational and sports activities and improved overall knee function.

Learn more about MACI at www.maci.com.

How does it work: A plug of carefully engineered aragonite (from coral heads , not coral reefs in the ocean) that  specially chosen for its bio active properties is implanted into the cartilage defect or early arthritis, thus producing a healing response in the bone as well as articular cartilage