Cartilage Injury
Cartilage Transplantation
Phone +971-2-4446600
Anatomy
Cartilage is the smooth surface of the joint surfaces that slide towards each other. Cartilage is a delicate tissue and we use the cartilage in the knees every time we move and therefore it get’s a bit worn out during the end of our lifetime. When the cartilage gets thinner without any specific injury, just by loading the knee, we call it osteoarthritis.
Sometimes, an injury to the knee can result in the cartilage being damaged in just one part of the knee and this is something completely different, but without treatment this has a very high risk of developing into osteoarthritis over time.
Signs of cartilage injury is pain from a certain area of the knee, recurrent swelling and sometimes a hinging or locking sensation when moving the knee in certain positions.
Evaluation
These injuries are sometimes hard to diagnose with examination and history, since the symptoms are similar to meniscal injuries. Therefore, the use of x-rays and MRI help to determine what structure is damaged and can be very informative in what the possible treatment options are.
When it comes to cartilage injuries, the size of the lesion is very important as this can rule out several treatments, so measurements of the lesions are done on the MRI.
Treatment
Large traumatic cartilage lesions are treated surgically as soon as possible to try to reduce the cartilage back to its anatomical position and fix it there. In young individuals with large lesions, an early good fixation for such lesion can fully heal and have no residual symptoms.
The smaller the lesions, the harder it is to fix it back to its origin, and therefore small lesions are usually first treated without surgery to evaluate if they become symptomatic or not. If they have symptoms going forward, a chondroplasty, meaning smoothening and cleaning of the cartilage area during an arthroscopy can be performed.
The medium sized lesions, if symptomatic, can be treated by osteoarticular transfer system (OATS) where small bone and cartilage plugs are taken from a less important area of the joint replacing the affected injured area that has a higher need for better cartilage. The site these bone plugs are taken from usually has very little symptoms afterwards.
The larger lesions that are not acute, basically having a part of the joint left without cartilage from a previous injury, can, if symptomatic, be treated with osteochondral allograft transplantation (OCA). This is a technique where we use a fresh donor graft to transplant much larger bone plugs into these large defects.
It is important to note that transplants, both from your own knee (OATS) and from donors (OCA) require good cartilage around the transplant site and can have some lingering pain afterwards, which is why this is not indicated when there is osteoarthritis in the knee to a higher degree or if there is only minimal symptoms.
OATS procedure, where plugs of your own cartilage are transferred to the injured part
OCA procedure, where donor cartilage plugs are transplanted into your knee.
Rehabilitation
With a smaller chondroplasty or cleaning of the affected area there is only a few weeks of rehabilitation time afterwards.
However, with all the other cartilage procedures the knee needs time to heal and during the first 6 weeks, no weightbearing is allowed and thereafter focus is on getting back to a normal walking pattern which usually takes up to three months in total.
Physiotherapy will start the day after the surgery and should be ongoing until you have reached the full potential of the knee.
An estimated time frame for recovery is 4 months to every day life with walking and biking, and up to a year to get back to full activities.