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. Damaged cartilage cannot cushion the joints during movement and the joints may rub over each other causing severe pain and inflammation.
Cartilage restoration is a surgical procedure where orthopedic surgeons stimulate the growth of new cartilage that restores the normal function. Arthritis condition can be delayed or prevented through this procedure.
Several techniques are employed for cartilage restoration including dietary supplements, microfracture, drilling, abrasion arthroplasty, osteochondral autograft, and allograft transplantation.
Dietary supplements: Dietary supplements such as glucosamine and chondroitin are the non-surgical treatment options for cartilage restoration. Chrondroitin sulphate and glucosamine are naturally occurring substances in the body that prevent degradation of cartilage and promote formation of new cartilage. Chrondroitin sulphate and glucosamine obtained from animal sources are available as over the counter products and are recommended for cartilage restoration. Apart from these various other nutritional supplements are also recommended such as calcium with magnesium and vitamin D as a combination, S-Adenosyl-Methionine and Methylsulfonylmethane.
Microfracture: In this method numerous holes are created in the injured joint surface using a sharp tool. This procedure stimulates healing response by creating new blood supply. Blood supply results in growth of new cartilage.
Drilling: In this method a drilling instrument is used to create holes in the injured joint surface. Drilling holes creates blood supply and stimulate growth of new cartilage. Although the method is similar to microfracture, it is less precise and the heat produced during drilling may damage other tissues.
Abrasion Arthroplasty: High speed metal-like object is used to remove the damaged cartilage. This procedure is performed using an arthroscope.
Osteochondral Autograft Transplantation: Healthy cartilage tissue (graft) is taken from the bone that bears less weight and is transferred to the injured joint place. This method is used for smaller cartilage defects.
Osteochondral Allograft Transplantation: A cartilage tissue (graft) is taken from a donor and transplanted to the site of the injury. Allograft technique is recommended if larger part of cartilage is damaged.
Autologous Chondrocyte implantation (ACI): In this method a piece of healthy cartilage from other site is removed using arthroscopic technique and is cultured in laboratory. Cultured cells form a larger patch which is then implanted in the damaged part by open surgery.
Autologous chondrocyte implantation (ACI) is a accomplished in two steps. The first step involves growing new cartilage cells followed by the implantation of these new cells into the defect.
The first step is done arthroscopically, during which healthy cartilage cells are removed from non-weight bearing area of the bone. These cells are then cultured in a laboratory, to increase their number. It takes about 3 to 5 weeks to receive the culture.
Implantation of the new cartilage cells is done through an open surgical procedure, arthrotomy. Arthrotomy involves preparation of the defect following which, a layer of the bone-lining (periosteum) is stitched over the defect and sealed with fibrin glue. The cultured cells are then injected into the defect just below the cover.
Autologous chondrocyte implantation is indicated in younger patients who have single and larger lesion (>2 cm diameter). As the patient’s own cells are used, there is no risk of tissue rejection which otherwise is common with the implants collected from the donor.
Following the surgery, rehabilitation procedures are advised to necessitate healing and to restore normal functioning of the joint.