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CARTILAGE IMPAIRMENT: HOW TO TREAT IT

Dr. K. Krishnaiah, Thursday, October 31, 2019

WHAT IS CARTILAGE AND HOW DOES IT GET DAMAGED?

Articular cartilage is a firm, rubbery material that covers the ends of bones in the knee joint. It reduces friction in the joint and acts as a "shock absorber." When cartilage becomes damaged or deteriorates, it limits the knee's normal movement and can cause significant pain. If damaged cartilage is not treated, it can worsen and eventually require knee replacement surgery.


WHO CAN GET TREATMENT FOR CARTILAGE DAMAGE?

The treatment is recommended for patients with knee cartilage damage or deterioration caused by:

  • Injury or trauma, including sports injuries
  • Repetitive use of the joint
  • Congenital abnormalities, meaning those that a person is born with, affecting normal joint structure
  • Hormonal disorders that affect bone and joint development, such as osteochondritis dessicans (OCD)

However, this procedure is not recommended for knees affected by osteoarthritis, a condition that causes natural cartilage deterioration from aging.


WHAT IS THE PROCEDURE?

Most knee procedures are performed arthroscopically, where the surgeon makes three small, puncture incisions around the joint using an arthroscope, a small device with a camera that provides a clear view of the inside of the knee.

Cartilage repair and regeneration procedures are as follows:

Autologous Chondrocyte Transplantation (ACI): In this procedure, firstly, healthy cartilage cells are arthroscopically removed from a non-weight bearing area of the knee. The cells are then grown in the laboratory for around six to eight weeks. An open surgical procedure, called an arthrotomy, is then done to implant the newly grown cells. A layer of tissue that covers the outer surface of bone, called periosteum, is sewn over the area and sealed with fibrin glue. The newly grown cells are injected into the defect under the periosteum.

Cell-based Cartilage Resurfacing: First, surgeons surgically remove cartilage cells from non-weight bearing areas of the knee joint. Cartilage cells are then grown in a lab before being implanted into a special 3-dimensional scaffold that functions as a type of house where cells live and continue to grow. Once a big enough piece of cartilage is grown, it is implanted back into the knee. A new bio adhesive, which makes implantation quick and easy, is used, taking about an hour to complete. Within months, the cartilage matures and integrates with existing cartilage.

Meniscus Transplant: This procedure is recommended for patients who have lost most of their meniscus or have had it removed. The meniscus provides cushioning and stability to the knee. A meniscus transplant involves transplanting the meniscus from a cadaver donor to restore the shock-absorbing capability of the knee.

Microfracture: Small holes are created in the knee bone. The surface layer of the bone, called the subchondral bone, is hard and lacks good blood flow. Creating holes in the bone allows bleeding. Blood contains bone marrow cells that stimulate cartilage growth and form fibrocartilage, which covers the injured area.

Osteochondral Allograft: If a cartilage defect is too large to be treated by an autograft, an osteochondral allograft may be required. Performed through an open incision, this procedure is similar to mosaicplasty, but the graft is taken from a cadaver donor, or a donor who has died. The graft is carefully sterilized and prepared before implantation and must match the anatomy of the patient. It is then shaped to fit the exact contour of a patient's defect.

Osteochondral Autograft Transplantation (Mosaicplasty): This procedure involves transferring healthy cartilage tissue, called a graft, from one part of the knee to the damaged area. The graft is taken as a "plug" of cartilage and underlying bone. A single plug of cartilage may be transferred or multiple plugs may be transferred in a procedure called mosaicplasty. When multiple plugs are moved to the damaged area, it creates a mosaic appearance.


WHY KIMS?

KIMS, one of the best orthopaedic hospitals in Hyderabad, is recognized in India as one of the leading institutions for the treatment of cartilage damage and early arthritis in the knees. Our expert, best orthopaedic surgeons do everything possible to treat the patients who come to the hospital, seeking to resume competitive sports or simply to walk comfortably again. We have also opened a branch and we are pleased to inform that it has become one of the best orthopaedic specialist hospitals in Kondapur.

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