Articular Cartilage Defect Surgery

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Articular cartilage is a very important component of a healthy knee joint. It covers the ends of each of the bones and is what allows for a fluid, smooth, painless motion of the knee. When an area of the cartilage becomes damaged, a patient will experience swelling and pain with activities, and over time, this process will continue to progress which eventually leads to complete loss of cartilage down to the bone.  When this happens, a diseases known as osteoarthritis becomes present. This continues to cause progressive symptoms of knee pain and stiffness.

When a patient presents with damage to the articular cartilage, or an articular cartilage defect, it is of the utmost importance to treat this appropriately in an effort to restore the damaged area and preserve the surrounding cartilage. This treatment will depend on many factors including size of the defect, depth, location, associated injuries in the knee, age, and activity goals. In many cases with a focal cartilage defect, surgery is recommended.

There are a variety of surgical procedures that can be used to treat articular cartilage damage. These include chondroplasty, Microfracture, osteochaondral autograft transfer, or osteonchondral allograft transplantation.  Listed below are some of the specific behind each technique:

  • Chrondoplasty is an arthroscopic procedure used on some patients which involves using a camera and small instruments to trim away the damaged area of cartilage to alleviate the patient’s symptoms and prevent further propagation of the defect. This procedure is typically undertaken in patients who do not have full thickness defects (down to bone).
  • Microfracture is a technique used in patients who have a full thickens loss of cartilage.  It is a technique where a small pick is used to make holes in the bony surface of the defect. This allows the flow of marrow elements and stem cells which form a clot over the defect and eventually cover the area with a fibrocartilage layer.
  • Osteochondral autograft transfer and osteonchondral allograft transplantations are two types of procedures where an autograft (taken from the patient) or allograft (taken from a donor) is used. In autograft OATs, small plugs of cartilage and bone are taken from another less important area of the patient’s knee and transferred in to fill the defect. In allograft OATs, the cartilage and bone are taken from a donor and also used to fill the defect. These procedures are done with a combination of arthroscopic and open techniques.

Physical therapy will be prescribed following surgery for an articular cartilage defect. Post-operative management varies depending on the specific type of procedure and the severity of the injury. For chondroplasty, patients are typically on crutches for a few days and allowed to weight bear as tolerated with full range of motion. For the other procedures the patient is placed into a brace and weight bearing is protected for 6-8 weeks. Motion may be initially restricted and a continuous passive motion machine (CPM) is also typically used for 6 weeks after surgery.

For additional information on osteoarthritis of the knee, or to schedule an appointment to discuss articular cartilage defect surgery or other treatments for this specific condition, please contact the Gulf Breeze, Florida orthopedic surgeon, Dr. Adam Anz located at the Andrews Institute. 

 

Knee Cartilage

Joint Preservation and Cartilage Restoration

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Knee Cartilage

Osteoarthritis can occur in the shoulder as a result of an injury or a degenerative process that comes with aging. This is usually associated with wearing away of the once smooth cartilage surface to reveal the underlying bone and is often associated with pain and stiffness in the shoulder. These mechanical changes are also accompanied by biologic and chemical changes within the joint that are usually not reversible.

The process of arthritis cannot be reversed but there are treatments available that are designed to decrease the pain and stiffness that comes with this disease. Arthritis of the shoulder can be treated a number of ways. Typically, for mild cases, patients are given oral anti-inflammatory medications and a physical therapy program aimed at strengthening the surrounding muscles. Steroids or joint fluid supplements can also be injected into the shoulder in an effort to decrease symptoms.

Surgical intervention for arthritis of the shoulder has historically been limited to joint replacement which removes the painful and diseased areas of the shoulder, replacing them with metal and plastic bearings. However, in patients that would like to prolong the use of their native shoulder before having a replacement, there is an arthroscopic alternative that aims to remove scar tissue and decrease pain. This surgery involves using small incisions and a small camera to remove loose pieces of cartilage and “clean up” the joint. The surgery also usually includes a release of the capsule as well as removal of the joint lining, which is a source of pain and is often inflamed. In some cases, microfracture is used to attempt to restore areas of degenerated cartilage. The microfracture procedure involves making tiny holes in the bone that releases healing elements in the area of cartilage loss. This blood fills the defect and turns into scar tissue that behaves like cartilage.

Knee Runner Pain

Following surgery, Dr. Anz will arrange for a physical therapy program that helps restore motion and increase the strength of the muscles that stabilize the shoulder. Patients will often benefit from the use of the sling in the early weeks following surgery. Patients are allowed to eventually return to activities with a progressive return to shoulder function.

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For additional information on the treatment for osteoarthritis of the shoulder, or for further resources concerning joint preservation and cartilage restoration, please contact the Gulf Breeze, Florida orthopedic surgeon, Dr. Adam Anz located at the Andrews Institute. 

Knee Cartilage Injury

Knee Cartilage Injuries

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Knee Cartilage Injury

Injury Overview

Cartilage is a type of tissue found in the joints of the body. Articular cartilage is a specific type that covers the ends of the bones within a joint allowing smooth, pain-free movement. There are other types of cartilage found in the joints as well.  This includes cartilage that covers the discs in the spine, or cartilage that makes up the meniscus of the knee. All forms of cartilage have varying properties and functions, however, articular cartilage is a form that is commonly injured in the knee. Articular cartilage is strong, but once damaged, the tissue has a very limited ability to heal because of its limited blood supply. Due to the limited healing potential of cartilage, articular cartilage injuries (often referred to as chondral injuries) may worsen if left untreated. When the deterioration and damage involves a large part of the joint and is accompanied by inflammation of the joint, the term applied to the injury is degenerative osteoarthritis.

Articular cartilage can become damaged through a number of ways.  These are highlighted below:

  • Cartilage can become damaged through sports accidents or acute trauma
  • When knee alignment is not perfect, chronic overuse and repetitive weight bearing can cause cartilage injury
  • Age plays a vital role in the health of articular cartilage. As an individual ages, cartilage can deteriorate due to our active lifestyles
  • Focal damage (injury to a small, specific localized area) to cartilage can range from softening of the cartilage to to complete detachment of a piece of cartilage leaving the underlying bone exposed.
  • Chondromalacia is a medical term describing cartilage injury with grading of 1 to 4. Grade 1 chondromalacia refers to softening of cartilage.  At the other end of the spectrum, grade 4 chondromalacia refers to a full thickness cartilage injury where the cartilage is worn down to bone or is detached as a full segment of cartilage.  An osteochondral defect (OCD) occurs when there is damage to both the cartilage and the bone layer below.

Symptoms

A constant, dull ache, accompanied with joint swelling and stiffness, are the most common symptoms associated with a cartilage defect or injury.  These symptoms can start as an ache and turn into chronic pain over time. If cartilage pieces become dislodged, they can cause popping and catching symptoms.  The symptoms will worsen with activity.  In early staged injuries, pain can be managed with conservative measures, while injuries that have progressed may benefit from a surgical procedure.

Diagnosis

Pain in the knee from a cartilage injury can mirror many other conditions. Because of this, Dr. Anz will gather as much information as possible during the initial interview and will conduct a thorough physical examination to evaluate the pain and mobility of the knee. An X-ray will be performed at the initial visit, and an MRI may also need to be obtained.  Once a cartilage injury has been diagnosed, Dr. Anz will assess the stage and level of injury and provide a treatment plan.

Treatment

Minor cartilage injuries often respond well to conservative treatment measures.  This includes avoiding activities that cause symptoms to flare up, as well as icing of the knee, elevation of the injured knee, anti-inflammatory medications, and physical therapy.

Surgical Treatment

For severe cases of cartilage damage, Dr. Anz may recommend a surgical treatment. Most treatments are in place to provide pain relief and mobility for patients.  The surgery performed for chondral damage will be based upon the grade of the injury as well as the method Dr. Anz believes will provide the best outcome. The patient’s age, activity level, fitness goals, and lifestyle, will all be taken into account before a treatment plan has been provided. Most of the procedures that are performed to treat cartilage defects can be done arthroscopically.  Dr. Anz offers the following procedures to treat articular cartilage injuries and chondral defects: Microfracture (marrow stimulation), debridement and chondroplasty,, and osteochondral allograft transplantation.  Experimental procedures utilizing stem cells are on the horizon for treating cartilage defects, and Dr. Anz has been directly involved with research in this area.

Post-Operative

Proper rehabilitation is one of the most important aspects of the effectiveness and successful outcome following a surgical procedure for articular cartilage injuries. Dr. Anz will consult with each patient regarding what is expected of them after surgery and will recommend a physical therapy rehabilitation program which should be fulfilled completely in order to achieve the most optimal results. The program will be broken down into phases that will consist of transitions from movement and mobility to strengthening and regaining full function of the knee.

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If you have any further questions or are interested in scheduling an appointment with Dr. Anz to discuss your symptoms, which you believe might be a cartilage injury of the knee, please contact the Gulf Breeze, Florida orthopedic surgeon, Dr. Adam Anz located at the Andrews Institute.