Cartilage Restoration & Transplantation

Articular Cartilage is the white tissue lining the end of bones where these bones connect to form joints. Cartilage acts as cushioning material and helps in smooth gliding of bones during movement. An injury to the joint may damage this cartilage which cannot repair on its own. Cartilage can be damaged with increasing age, normal wear and tear, or trauma. Osteoarthritis is the degeneration of articular cartilage over time. Damaged cartilage cannot cushion the joints during movement and the joints may rub over each other causing pain, inflammation and further joint degeneration.

The field of cartilage restoration seeks to replace damaged cartilage as an alternative to joint replacement. Cartilage transplantation is a procedure to restore articular cartilage in a joint by transplanting it from another region of your body or using cartilage from a donor.

Indications for Cartilage Transplantation

Cartilage transplantation is indicated for cases of mild-to-moderate cartilage loss where joint replacement is not recommended. Ideally, you should be

• Under the age of 45
• Should not be obese
• Should not have conditions such as rheumatoid arthritis or severe osteoarthritis that complicate joint health nor have bone-on-bone changes that may otherwise be more appropriately treated with knee replacement surgery

Types of Cartilage Transplantation

There are various techniques used to transplant cartilage. Based on the size and location of your defect, among other factors, your doctor will recommend the appropriate procedure for you. Some of the procedures include:

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Specific Procedures

Microfracture/BioCartilage/AutoCart Minced Cartilage

Microfracture is a surgical technique used to repair damaged articular cartilage. An awl or drill is used to create small holes in the joint surface, releasing bone marrow elements that stimulate the growth of fibrocartilage. Microfracture may be augmented with BioCartilage (dehydrated, micronized allogenic cartilage) and/or AutoCart Minced Cartilage (autologous cartilage). BioCartilage consists of dehydrated cartilage, which is combined with either bone marrow concentrate, platelet-rich plasma, and/or autologous cartilage harvest (AutoCart). This mixture can be used as an allograft equivalent to treat localized cartilage defects. Before BioCartilage placement, the defect is smoothed and microfractured to introduce blood supply and stimulate new cartilage to grow. The BioCartilage is placed over the microfractured defect, smoothed into place, and covered with a sealant.

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DenovNT

DeNovo NT is a minced juvenile articular cartilage allograft. It is used as a cell-based cartilage restoration procedure to treat full-thickness cartilage lesions in a single surgery. The DeNovo graft consists of pieces of viable donor cartilage in a storage media. Similar to MACI, the damaged cartilage area is prepared and sized. The graft is then prepared with a fibrin sealant and placed on the defect. The sealant precludes the need of a collagen membrane.

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Matrix Associated Cartilage Implantation

Cartilage is harvested from the joint and cultured in a laboratory. A second surgery is performed to implant the cartilage tissue into the joint. This procedure is indicated for medium-to-large areas of cartilage deficiency.

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Osteochondral autograft transplantation

Cartilage with underlying bone is transplanted from a stress-free region of the joint to the deficient (load-bearing) area. This procedure is indicated for small areas of cartilage deficiency.

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Osteochondral allograft transplantation

Donor cartilage is shaped and fit into a cartilage-deficient area, creating a smooth surface. This procedure is indicated for medium-to-large areas of cartilage deficiency.

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Subchondroplasty/Bioplasty

Subchondroplasty/Bioplasty are surgical procedures used to treat bone marrow edema/lesions. A drill is used to create tunnels in the affected bone, and synthetic bone substitute or bone marrow concentrate with an inductive/conductive bone matrix is used to fill the tunnel.

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Meniscus allograft transplantation

This procedure is usually performed in the knee for areas of meniscal deficiency. A donated meniscus is size-matched and sewn into place. Meniscal transplantation is usually indicated where there is pain following previous meniscus removal.

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Osteotomy of the femur and tibia

An osteotomy is a surgical bony procedure. It can be used to treat knee malalignment or to offload joint pressure after cartilage transplantation. The bone is cut and adjusted to a more favorable position, and a bony substitute or bone allograft may be used to fill the area of the bone cut and a plate and screws are used to fix the area.

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