Cartilage restoration is a procedure used to restore knee health and improve function while decreasing pain. When you’re an active adult with knee pain and conservative treatments no longer provide relief, it can be difficult to know what to do next. The Ohio State University Wexner Medical Center in Columbus, Ohio, is home to a team of expert orthopedic knee surgeons who specialize in advanced knee-preserving techniques, including cartilage repair. We’re one of only a few places in Columbus, Ohio, where cartilage restoration is available as a treatment option for knee pain.
What is cartilage restoration?
Knee cartilage restoration, also called cartilage repair or cartilage regeneration, is a procedure to repair damaged tissue inside your knee. Cartilage covers the ends of the bone in your knee to provide a smooth gliding surface during movement.
Cartilage serves an important purpose as it reduces friction in your knee joint and makes movement smooth and painless. It also acts as a shock absorber to prevent traumatic injury to your bones. Unfortunately, cartilage can’t repair itself when it’s damaged, because it doesn’t receive a lot of blood flow.
When you damage your cartilage from an injury or overuse, we can sometimes repair it using various restoration techniques, including replacing it with donor tissue (allograft, or cartilage transplant) or man-made material. Sometimes we’re able to stimulate your own body’s growth of cartilage through innovative methods.
Is cartilage restoration right for me?
David Flanigan, MD, orthopedic surgeon, describes who is a candidate for cartilage restoration. The best candidates are those under the age of 50 who have a "pothole" of missing or damaged cartilage in their knee.
Who is a candidate for cartilage restoration?
While cartilage restoration repairs damaged cartilage, not everyone who has worn-down or damaged cartilage is a candidate for restoration. Cartilage is very difficult to restore when it’s completely worn down from arthritis, for example. These people may be candidates for other knee surgeries, including knee replacement.
You might be a candidate for cartilage repair if you:
- Are a younger adult, typically younger than 50
- Have one or only a few lesions, or “potholes,” in your cartilage
If you’re a good fit for cartilage restoration, we have knee specialists who are experts at identifying who would benefit most from this type of treatment.
Most commonly, cartilage restoration is performed on the knee, but repairs can also be done on other joints, such as the shoulder or ankle.
What is the benefit of cartilage restoration?
The biggest benefit of cartilage repair is that it preserves the knee and can delay the onset of arthritis, thus delaying the need for a knee replacement. Cartilage restoration is less invasive than replacement, allowing people to return to their favorite activities faster and keep more of their natural knee function.
Knee cartilage restoration options at Ohio State
David Flanigan, MD, orthopedic surgeon, describes the knee cartilage restoration options available at the Ohio State Wexner Medical Center that can restore your knee health, improve function and decrease pain.
How is cartilage restoration performed?
There are several different types of cartilage repair surgery, and your knee surgeon will choose the right one for you depending on a variety of factors, including the extent of cartilage damage, your overall knee health and your goals for surgery.
Microfracture
In this procedure, tiny holes are made in the base of the cartilage injury with a sharp tool, which can promote a healing response and stimulate cartilage growth. This is typically used for small areas of cartilage damage and is an effective short-term solution for knee cartilage defects.
Drilling
During this procedure, tiny holes are drilled in the damaged cartilage to encourage blood flow and healing to the injured area. It can be a bit less precise than microfracture and has added risks.
Abrasion arthroplasty
Instead of using wires or drills to remove damaged cartilage and stimulate cartilage growth, this procedure uses a high-speed tool.
Autologous chondrocyte implantation
Also known as ACI or MACI, this method requires two surgeries. During the first procedure, your surgeon takes a small sample of healthy cartilage from a nonessential area of the joint. Then, those cartilage cells are isolated and grown in a lab. Finally, a second surgery is performed to glue a patch of your own cartilage cells onto your cartilage injury.
Osteochondral autograft transplantation
Your surgeon will take a plug of healthy cartilage and bone from another part of the knee, (an autograft) and transplant it to the damaged cartilage. This is typically used for smaller cartilage defects.
Osteochondral allograft transplantation
Your surgeon will take a plug of cartilage and bone from a donor and transplant it to your damaged cartilage. With this method, we can repair larger defects in the cartilage.
What to expect with cartilage restoration
Facing a surgery like cartilage restoration can be intimidating, but knowing what to expect can help calm some of those nerves. Our expert knee team will make sure you’re well prepared and will walk you through each step.
Before cartilage restoration
You’ll have a physical exam to look at your range of motion, amount of swelling and knee alignment. We also may recommend magnetic resonance imaging (MRI) to help us determine where the cartilage damage is and the best treatment.
It’s important to follow instructions about when to stop medications and how long to avoid food and water before surgery. Also, you’ll need to arrange transportation home from the hospital.
During cartilage restoration
You won’t feel pain during surgery since you’ll be under general anesthesia (fully asleep) or be administered spinal anesthetic.
In some cases, cartilage repairs can be made arthroscopically, a minimally invasive technique that involves making small incisions and using a small tube (arthroscope) with a camera and light on the end of it to perform the surgery. Sometimes open surgery with larger incisions is necessary to access the injured area.
Cartilage restoration surgery typically lasts one hour or less, but can sometimes be longer if other areas of the knee are repaired at the same time.
After cartilage restoration
You’ll wake up in recovery, and most likely go home the same day as the surgery. Patience in resting your knee until your doctor says it’s safe to return to activity is key to successful outcomes. Some steps to help in your recovery include:
- Elevating and icing your knee to prevent swelling
- Using crutches or a brace to avoid bearing weight on your knee
- Keeping the surgical area clean and dry
- Attending follow-up appointments and physical therapy sessions
- Taking prescribed medications as directed
How long does it take to recover from cartilage restoration?
Recovery time will vary depending on the type of procedure you have. Most people will be on crutches for the first few weeks following surgery and able to resume daily activities within six weeks. To be cleared for sports will take longer –– at least six months to a year.
Risks of cartilage restoration
Cartilage repair is a relatively safe surgery, but as with any procedure, there can be complications or risks. Some risks include:
- Postoperative bleeding
- Blood clots
- Infection
- Knee joint stiffness
- Numbness around the incision
- Injury to vessels, nerves or healthy cartilage
- Failure of the surgery to relieve pain
Why come to Ohio State for cartilage repair?
The knee specialists with Ohio State Sports Medicine have a strong emphasis on providing innovative alternatives to treat knee pain and finding new ways to preserve the knee. Our robust cartilage restoration program is one great example of that. Other differentiators include:
- We provide a level of cartilage repair care not available in most places. We’re one of the only hospital systems in central Ohio that offers cartilage restoration. Our surgeons are also expertly trained in various restoration techniques, making Ohio State’s breadth of available options for cartilage repair unparalleled in Ohio and the region.
- We’re constantly researching new ways to treat cartilage damage. As an academic medical center, we’re a leader in the field by bringing the most innovative randomized clinical trials to you. Currently, we’re leading trials looking at new implant materials and how to make cartilage restoration more permanent.
- We champion joint preservation. While some people are clear candidates for joint replacement surgery, many others can benefit from knee-preserving procedures like cartilage restoration. For those who want to stay active as they age, we’re the clear choice for orthopedic knee care.