Cartilage Regeneration (microfracture, Cartilage Transplantations and stem cell trials)

What is Cartilage Regeneration for the Knee?

When the articular cartilage inside the knee gets torn or damaged, Cartilage Regeneration (Microfracture, Cartilage Transplantations and Stem Cell Trials) provides options for repairing it. With the Microfracture procedure, tiny holes or microfractures are bored into the bone to encourage the formation of cartilage. In Cartilage Transplantations, cartilage is taken either from the patient or a cadaver and grafted in place of the patient’s damaged cartilage. Cartilage repair using a collagen 3 Dimensional scaffold via keyhole surgery is also an option for localised cartilage defects.

Active people under the age of 40 are the usual candidates for Cartilage Scaffold Repair if they have experienced Knee Pain for months (not years) even when they are resting. Those with cartilage damage in just one or two areas in the knee may also opt for this treatment.

Others who may benefit from Cartilage Regeneration treatment include those who may have damaged their knee cartilage through repetitive use or in an accident.

People with knee pain whose knees are deficient in cartilage, those who were born with an abnormal knee structure, and those with a hormonal disorder like Osteochondritis Dessicans which affects the development of the joints and bones may likewise benefit.

People suffering from Osteoarthritis, particularly the elderly, may be able to benefit from Stem Cell treatment in particular.

Microfracture is not recommended for those with poorly aligned knees or older patients (usually over age 65) who may have trouble using crutches or following the rehabilitation programme after surgery. It is also not recommended for those with rheumatoid arthritis or other diseases affecting the immune system.

The surgeon uses an arthroscope in the Microfracture procedure where he first takes stock of the damaged cartilage. He will remove unstable and loose pieces of cartilage, leaving a stable piece around the defective or damaged area. Several holes or microfractures will then be drilled into the bone spaced approximately 3 to 4mm apart to allow bone marrow and blood to come out.

The bone marrow and blood that comes out is allowed to cover the damaged cartilage so that tissue can form there. The holes also serve as surface preparation that will make it easier for the tissue to attach. It takes about two to six months for the tissue to form and for the patient to experience decreased pain and be able to move the knee more.

In Cartilage Transplantations, a graft is either taken from the patient, or a cadaver or donor. When the graft is taken from the patient, the surgeon has two options. In Osteochondral Autograft Transplantation, the surgeon gets a healthy piece of cartilage from a part of the knee that does not bear weight, and transfers it directly into the damaged area.

With Cartilage repair, a 3 Dimensional scaffold is placed to cover the defect and tissue glue is used to hold this scaffold in place for healing.

In Autologous Chondrocyte Implantation, the healthy piece of cartilage that is taken from the patient is kept for cultivation. The cultured cartilage cells, which take about three to five weeks to develop, are later implanted into the damaged knee.

With Stem Cell therapies, adult stem cells in particular are extracted from fat and bone marrow using minimally invasive procedures. They are then injected into the knee where they can head towards inflamed and damaged areas and differentiate into tissue and cartilage.

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The surgical risks involved include infection, bleeding, blood clots, breathing difficulties, and an adverse reaction to certain medications.

Patients who have undergone the Microfracture procedure in particular might experience a little on-and-off pain, or a sort of “scraping” feeling in the knee when the knee brace is removed. It usually takes a few days to weeks for this scraping feeling to go away by itself. Others experience swelling and the presence of fluid in the knee, but these also go away in about eight weeks.

Note that the cartilage produced through Microfracture is prone to breakdown after an extended period because it is not as tough as naturally formed cartilage.

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Tell your surgeon if you are taking any medications, herbs or supplements without a prescription. Ask your surgeon which, if any, are safe to take up to the date of the procedure. You may have to stop taking medications that might hinder the ability of your blood to clot such as naproxen, ibuprofen and aspirin.

Also let your surgeon know whether you’ve had a cold, fever or any illness before the procedure. Tell him whether you have more than one or two alcoholic drinks daily, or whether you smoke. If you do smoke, do your best to stop, because smoking can hinder the healing process for your bones and surgical wounds.

If you have medical conditions such as diabetes or heart issues you will have to see the specialists who treat you for them before having the procedure.

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It generally takes several months to make a full recovery from a cartilage regeneration procedure, during which time the surgeon may do follow-up monitoring to make sure the cartilage is adapting properly. To facilitate recovery from the Microfracture procedure, full co-operation with the rehabilitation programme following surgery will be necessary.

This includes the use of a continuous passive motion (CPM) machine, or bending and straightening exercises. Using crutches will be recommended for about six to eight weeks, provided that minimum weight is placed on the injured leg. Other exercises include movements in deep water and using a stationary bike as early as one to two weeks following the procedure.

The exercises may gradually become more strenuous after eight to 16 weeks, but it is important not to play any sports involving jumping and pivoting for four to six months after surgery. Get the approval of the surgeon first before attempting to return to these sports.

Pain is your body’s way of telling you that something is not right. Don’t just brush it off and risk the chance of comprosing your movement and interupting your daily activities. Get it checked today for the right intervention the soonest possible time. Book your appointment with Dr. Dutton, here.