Cartilage Repair and Restoration Surgery
Repairing Damaged Cartilage to Restore Joint Health and Improve Mobility
Articular cartilage, or hyaline cartilage, is a smooth, protective tissue that covers the ends of bones within your knee joint. Its purpose is to allow fluid motion and reduce friction between the bones, helping your knee move smoothly and without pain. Cartilage is, however, vulnerable to damage, often caused by direct injury to the knee. When this occurs, it can lead to symptoms such as swelling, stiffness, locking, and restricted movement. Unlike many other tissues in the body, articular cartilage has a very limited capacity to heal on its own. Once damaged, it can begin to wear down, often initiating the early stages of osteoarthritis (OA), where the cartilage deteriorates further over time.
Because cartilage does not regenerate easily on its own, several advanced surgical techniques have been developed to stimulate cartilage growth and restore joint function. These procedures are designed not only to relieve pain and improve mobility but also to delay or prevent the progression of osteoarthritis.
Dr Liddell will also discuss the potential benefits of removing the osteotomy plate at this point. Although plate removal is not mandatory, it is often recommended, especially if the plate causes discomfort or is prominent under the skin. The plate is designed to be robust and withstand the force of your body weight, but in some cases, it can be felt through the incision site, which may cause discomfort.
If further knee surgery is required in the future, such as a knee replacement, the presence of the plate can complicate the procedure. Removing the plate several years after surgery can also be more challenging due to bony ingrowth and overgrowth. It is therefore typically performed 9 to 12 months after the initial surgery once the osteotomy site has completely healed.
Plate removal is relatively straight forward and is usually an outpatient procedure, meaning you won’t need to stay overnight in the hospital.
CHONDROPLASTY
Smoothing and Stabilising Damaged Cartilage
Chondroplasty is a minimally invasive surgical procedure that smooths and stabilises damaged cartilage in the knee joint. This can help relieve discomfort, improve your mobility, and prevent further joint damage. It’s often recommended for patients with mild to moderate cartilage damage, where the goal is to reduce symptoms and improve function without the need for more extensive surgery.
Chondroplasty is typically performed using arthroscopy, a minimally invasive technique that allows Dr Liddell to repair the cartilage through small incisions. A tiny camera, called an arthroscope, is inserted into the knee, allowing a detailed view of the joint on a monitor. Using specialised tools, Dr Liddell smooths the rough, or frayed cartilage and removes any loose fragments. This creates a more even surface within the joint, reducing friction and alleviating your symptoms, like pain and stiffness.
One of the main benefits of chondroplasty is that it’s a minimally invasive procedure, meaning you’ll likely experience a quicker recovery compared to more complex surgeries. Because the procedure only involves smoothing and stabilising the existing cartilage, there is minimal disruption to the surrounding tissues which allows for a faster healing process.
Since chondroplasty is less invasive, you’ll typically have less pain and swelling after the surgery, allowing you to start rehabilitation sooner. Many patients are able to resume light activities within a few weeks.
By removing loose cartilage and smoothing damaged areas, chondroplasty can effectively reduce pain, swelling, and joint stiffness, improving your overall knee function.
Smoothing rough cartilage helps protect the joint from further wear and tear, potentially slowing down the progression of conditions like osteoarthritis.
While chondroplasty offers many benefits, it’s important to understand its limitations. Unlike some other cartilage repair procedures, chondroplasty doesn’t stimulate the growth of new cartilage. This means the procedure focuses on improving symptoms rather than regenerating cartilage.The symptom relief provided by chondroplasty may also be temporary, especially if the cause of the cartilage damage isn’t fully addressed. In some cases, patients may eventually require additional treatments or even joint replacement as the condition progresses
Chondroplasty is often recommended for individuals with early-stage cartilage damage who are looking to reduce pain and maintain an active lifestyle. If you’re not yet a candidate for more invasive surgeries, or if you want to manage your symptoms and preserve your knee function, chondroplasty could be a suitable option. Dr Liddell will thoroughly assess your knee condition, including the extent of your cartilage damage, to determine whether chondroplasty is the best course of action for your condition.
MICROFRACTURE
Stimulating Cartilage Growth for Knee Repair
If you have cartilage damage in your knee, microfracture may be a suitable option to help repair the affected area and improve joint function. This minimally invasive procedure encourages your body’s natural healing process to generate new cartilage, which can reduce pain and improve mobility. Microfracture is often recommended for patients with small, localised cartilage damage, such as those caused by injury or early-stage osteoarthritis. Unlike procedures that involve grafting or implanting new tissue, microfracture works by stimulating your body to create new cartilage within the damaged area.
Microfracture is performed using arthroscopy, a minimally invasive technique. Small incisions are made, and an arthroscope—a thin tube with a camera—is inserted into the knee joint, allowing Dr Liddell to view the inside of the knee with precision.
Debridement: Dr Liddell will clean the damaged area by removing any loose or unstable cartilage. This prepares the site for the microfracture technique.
Creating Microfractures: Using a specialised tool called an awl, Dr Liddell makes small holes, or “microfractures,” in the bone beneath the damaged cartilage. These tiny holes allow blood and bone marrow cells to enter the damaged area.
The blood and bone marrow cells form a clot in the affected area, which contains stem cells and growth factors that promote new cartilage formation.
Over time, the clot develops into a new layer of cartilage. It’s important to note that this new cartilage, known as fibrocartilage, is not as strong or durable as the original hyaline cartilage but can still offer functional improvement.
Benefits of Microfracture
Microfracture can be an effective option for patients with small areas of cartilage damage.
Some potential benefits include:
Because microfracture is performed arthroscopically, it involves smaller incisions, which can result in less postoperative pain and a quicker recovery compared to more invasive procedures.
The procedure uses your body’s natural healing mechanisms to repair the damaged cartilage, making it a less complex option for suitable patients.
Repairing damaged cartilage early may help slow the development of osteoarthritis, potentially postponing the need for more extensive surgery like a joint replacement.
Patients may experience reduced pain and improved mobility, which can allow them to return to daily activities more comfortably.
Limitations of Microfracture
While microfracture can be beneficial, it’s important to understand its limitations:
The new cartilage formed after the procedure is fibrocartilage, which is not as strong or durable as the original hyaline cartilage. This may affect the long-term success of the procedure, particularly in individuals who are very physically active.
Recovery from microfracture can take several months and requires a period of non-weight-bearing to allow the new cartilage to form properly. A strict rehabilitation plan is necessary for optimal results.
Microfracture is most effective for small, isolated areas of cartilage damage. Patients with larger or more widespread damage may need alternative treatments.
Recovery and Rehabilitation After Microfracture
Recovery from microfracture requires dedication to a structured rehabilitation plan to protect the new cartilage and promote healing.
Here’s what to expect:
After surgery, you will likely need to avoid putting weight on the affected knee for several weeks. Crutches are often used to assist with mobility and protect the healing cartilage.
A tailored physiotherapy program is essential. Early stages focus on restoring range of motion, while later stages strengthen the muscles around the knee to support the joint.
You’ll gradually resume normal activities over several months, but high-impact activities such as running or jumping should be avoided until the knee is fully healed and Dr Liddell gives clearance.
Is Microfracture Right for You?
Microfracture may be a suitable option for patients with small, localised cartilage damage who wish to repair their knee without undergoing more invasive surgery. It is particularly effective for younger patients or those with early-stage damage who are looking to delay the progression of osteoarthritis. Dr Liddell will carefully evaluate your knee condition, including the size and location of the cartilage damage, to determine if microfracture is the most appropriate treatment option for you.
MATRIX-INDUCED AUTOLOGOUS CHONDROCYTE IMPLANTATION (MACI)
Regenerating Cartilage for Long-Term Knee Health
Matrix-Induced Autologous Chondrocyte Implantation (MACI) is an advanced cartilage repair technique designed to regenerate new, healthy cartilage in the knee. If you have a larger or more complex cartilage defect, MACI could offer a long-term solution to relieve pain and improve knee function. This procedure is particularly suited for patients whose cartilage damage is too extensive for simpler techniques, such as microfracture. MACI uses your own cartilage cells, which are harvested, cultured, and re-implanted into the damaged area, helping restore the joint and potentially delaying the progression of conditions like osteoarthritis.
How is MACI Performed?
MACI is a two-step procedure that involves harvesting your own cartilage cells and then re-implanting them to repair the damaged area of the knee. Here’s an overview of how the process works:
In the first stage, Dr Liddell performs a minor arthroscopic procedure to collect a small sample of healthy cartilage from a non-weight-bearing area of your knee. This sample is sent to a specialised lab, where the cartilage cells (chondrocytes) are cultured and expanded over a few weeks.
Once the cells have been grown in the lab, they are embedded into a biocompatible scaffold, or matrix, which serves as a support structure for the new cartilage to develop.
The second stage involves implanting the cell-laden matrix into the damaged area of your knee. This is typically done through a small incision (arthrotomy) to ensure the matrix is securely placed in the cartilage defect. Over time, the matrix allows the new cartilage to grow and integrate with the surrounding tissue.
Benefits of MACI
MACI offers several key benefits, especially for patients with larger cartilage defects. Here’s why it might be a good option for you:
Unlike other procedures that generate less durable fibrocartilage, MACI promotes the growth of hyaline-like cartilage. This type of cartilage is more similar to your original cartilage, making it more resilient and better suited to withstand the demands of daily activities.
Because MACI uses your own cartilage cells, the newly formed cartilage is highly compatible with your knee, reducing the risk of complications or rejection.
MACI is particularly beneficial for larger cartilage defects, usually greater than 2 cm², where simpler techniques may not be sufficient to restore knee function.
Delays or Prevents Osteoarthritis: By repairing cartilage with durable tissue, MACI can relieve pain, improve knee mobility, and potentially delay or prevent the onset of osteoarthritis.
By repairing cartilage with durable tissue, MACI can relieve pain, improve knee mobility, and potentially delay or prevent the onset of osteoarthritis.
Limitations of MACI
While MACI offers long-term benefits, there are some factors to consider when deciding if it’s the right option for you:
MACI requires two separate surgeries—one to harvest the cartilage and another for the implantation—making it a more involved process compared to other treatments.
Because MACI involves regenerating new cartilage, recovery can take longer. Patients need to follow a strict rehabilitation plan to ensure the best results.
MACI is a specialised procedure and may not be as widely available as other treatments. Additionally, the cost of the procedure is higher due to the complexity of cell culture and matrix preparation.
Recovery and Rehabilitation After MACI
Recovery from MACI is a gradual process that requires a structured rehabilitation plan. Here’s what you can expect during recovery:
After the surgery, you will need to avoid putting weight on the affected knee for several weeks. Crutches are commonly used during this time to protect the new cartilage.
A customised physiotherapy program is crucial for your recovery. Early rehabilitation focuses on restoring gentle range of motion, while later stages will involve strengthening exercises to support the knee.
Over time, you can gradually increase your activity level, with an emphasis on low-impact exercises such as swimming or cycling. High-impact activities should be avoided until the knee is fully healed, which may take several months.
Is MACI Right for You?
MACI may be a good option if you have significant cartilage defects and are looking for a long-term solution to manage knee pain and improve joint function. It is particularly suited for younger, active patients who wish to maintain a high level of physical activity and potentially delay or avoid the need for knee replacement surgery. Dr Liddell will assess your knee condition, including the size and location of the cartilage defect, and determine if MACI is the most appropriate treatment for your needs.
OSTEOCHONDRAL AUTOGRAFT TRANSPLANTATION (OATS)
Restoring Joint Function with Healthy Cartilage
Osteochondral Autograft Transplantation (OATS) is a surgical procedure designed to repair damaged cartilage in the knee by transplanting healthy cartilage and bone from one area of your knee to another. This approach is highly effective for treating small to medium-sized areas of cartilage damage, known as osteochondral defects, where both the cartilage and underlying bone have been affected. By using your own healthy tissue, OATS offers a durable and natural repair that can help restore joint function and reduce pain.
How is OATS Performed?
OATS can be performed using either an arthroscopic or open surgical technique, depending on the size and location of the cartilage defect. The procedure involves the following steps:
Dr Liddell will identify a healthy, non-weight-bearing area of your knee from which to harvest a small, cylindrical plug of cartilage and bone. This autograft provides both the cartilage and bone needed to repair the damaged area.
The damaged area of your knee is carefully prepared by creating a matching cylindrical hole in the cartilage defect. This hole is sized to precisely fit the harvested graft, ensuring a snug fit for optimal integration.
The harvested graft is then press-fitted into the prepared hole in the damaged area. The cartilage sits on top of the bone, restoring the smooth surface of your knee joint and allowing it to function properly.
Once the graft is securely in place, Dr Liddell ensures that it is properly aligned and stable before closing the incision and moving you to recovery.
Benefits of OATS
OATS offers several advantages for patients with localised cartilage damage, making it a strong option for restoring knee function and relieving pain:
OATS transplants hyaline cartilage, the same type of durable, resilient tissue that naturally lines your knee joint. This provides a long-lasting, robust repair compared to other techniques that result in fibrocartilage, which is less durable.
By transplanting both cartilage and bone, OATS provides immediate structural support to the affected area, helping to restore the natural function and stability of your knee joint.
OATS is particularly well-suited for repairing small to medium-sized defects (usually less than 2 cm²), making it a good option for treating isolated injuries or wear in the knee.
Because the graft comes from your own body, there is no risk of tissue rejection or disease transmission, and the graft is fully compatible with the surrounding tissue.
Limitations of OATS
While OATS is an effective procedure, there are some limitations to consider:
Harvesting the graft from a non-weight-bearing area of your knee can sometimes cause discomfort or issues at the donor site, though this is typically mild and temporary.
OATS is best suited for small to medium-sized defects. If you have larger areas of cartilage damage, other procedures, such as Matrix-Induced Autologous Chondrocyte Implantation (MACI), may be more appropriate.
Recovery from OATS can take time, as the transplanted graft needs to integrate with the surrounding tissue. A structured rehabilitation program is essential for a successful outcome.
Recovery and Rehabilitation After OATS
Recovering from OATS requires patience and dedication to a rehabilitation plan.
Here’s what you can expect during the recovery process:
After surgery, you’ll likely need to avoid putting weight on your knee for several weeks to protect the graft. Crutches or other assistive devices will help you move around during this time.
Physiotherapy is key to restoring knee function and strength. Early stages of rehab focus on gentle range-of-motion exercises to prevent stiffness, while later stages involve strengthening exercises to support the knee.
As the graft integrates and your knee heals, you can gradually return to low-impact activities like swimming or cycling. High-impact activities, such as running or jumping, will need to be avoided until your knee is fully recovered, which can take several months.
Is OATS Right for You?
OATS is an excellent option for patients with localised cartilage damage who are looking for a durable and natural solution to knee pain and dysfunction. This procedure is particularly beneficial for younger, active individuals who want to maintain a high level of physical activity and prevent further joint deterioration. Dr Liddell will carefully assess the size and location of your cartilage defect and determine whether OATS is the most suitable treatment option for you.