Cartilage Restoration: Knee
What is Cartilage Transplantation?
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.
What is Articular Cartilage?
Articular cartilage is the white tissue lining the ends of bones that form joints. It acts as cushioning material and helps in the smooth gliding of bones during movement.
How is Articular Cartilage Lost?
An injury to the joint may damage articular cartilage, which cannot repair on its own. Cartilage can be damaged with increasing age, normal wear and tear, overuse or trauma. Damaged cartilage cannot cushion the joints during movement and the bones may rub against each other causing severe pain and inflammation.
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
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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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Post operative care
Rehab Protocols
DeNovo NT
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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Post operative care
Rehab protocol
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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Post operative care
Rehab protocol
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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Post operative care
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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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- Osteochondral Allografts: Pearls to Maximize Biologic Healing and Clinical Success
- SBRATE Webinar: Decision Making in an Active Patient with Articular Cartilage Disease
- ON Foundation Case Presentation 2020: Osteochondral Defect of the Humeral Head
- Grand Rounds Live Webinar: Massive Rotator Cuff Tear and Articular Cartilage Lesion in an Athlete’s Knee
- Using osteochondral allograft transplantation to treat articular cartilage lesions of the knee
- Live Surgical Demonstration of Lateral Meniscus and Osteochondral Allograft Transplantation
- Osteochondral Allograft Transplantation of the Patella Live Broadcast Surgery
- Approach to a Professional Collision Athlete with a Full-thickness Cartilage Defect of the Medial Femoral Condyle: High Tibial Osteotomy with an Osteochondral Allograft
- Approach to a Professional Athlete with Multiple Articular Cartilage Defects: Multiple Osteochondral Allografts
- Osteochondral Allograft from 2015 Chicago Sports Medicine Symposium, Brian Cole MD MBA Live Broadcast
- Osteochondral Allograft from 2016 Chicago Sports Medicine Symposium, Brian Cole MD MBA Live Broadcast
- Fresh Osteochondral Allograft Transplantation of LFC after Meniscus Transplantation
Post operative care
Rehab protocol
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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Post operative care
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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Dr. Cole’s related videos
- AANA Webinar – Meniscus Transplantation: 2+ Decades of Experience (2020)
- Live Surgical Demonstration of Lateral Meniscus and Osteochondral Allograft Transplantation
- Meniscus Allograft Transplant and Osteochondral Autograft Transplant Live Broadcast Surgery
- Allograft Meniscus Transplantation using Bridge in Slot Technique
- Case Presentations: Cartilage, Meniscus, Patella
- Fresh Osteochondral Allograft Transplantation of LFC after Meniscus Transplantation
- Meniscus Allograft Transplantation: Indications, Techniques, Results
- Meniscus Transplantation (no audio)
- Live Surgical Demonstration of Lateral Meniscus and Osteochondral Allograft Transplantation
- Meniscus Allograft Transplant and Osteochondral Autograft Transplant Live Broadcast Surgery
Post operative care
Rehab protocol
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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Dr. Cole’s related videos
- Approach to a Young Female with Patellofemoral Cartilage Damage: Tibial Tubercle Osteotomy with Multiple Osteochondral Allograft Plugs
- Approach to a Professional Collision Athlete with a Full-thickness Cartilage Defect of the Medial Femoral Condyle: High Tibial Osteotomy with an Osteochondral Allograft
- High Tibial Osteotomy (no audio)
- Tibial Tubercle Osteotomy