Operative Treatments: Surgical Restoration

Meniscal Restoration

The goal of meniscal surgery is to maintain the cartilage function.  Preserving meniscal  functionality is a top priority but nearly 90% of tears cannot be repaired so the torn portion  is surgically removed.  Although this falls into the category of only a partial meniscectomy,  the outcome is still the same and from a functional perspective, it results in the same  outcome as a total meniscectomy.  Arthritis often results over time.  Meniscal transplantation  involves the use of a size-matched cadaver donor meniscus that is transplanted into the site  of the original meniscus with the intent of regaining meniscal function.

Arthroscopic Chondroplasty & Microfracture

For patients who have had the meniscus removed, the surgeon may offer an innovative solution  called a meniscal transplant. It is important to remember that even though only a part of the  meniscus was removed, at times the effect to the knee from a biomechanical standpoint is the  same as a total menisectomy. The indications for transplant need to be assessed by your  cartilage surgeon. Unlike other forms of tissue transplantation, this procedure does not  require patients to be on medications to prevent rejection. Intermediate term follow-up  studies in the literature are encouraging.

Articular Restoration

The articular cartilage that covers the bones at the joint experiences a constant wear  and tear.  The cells of the articular cartilage, called the chondrocytes, make the matrix  or this  external covering of the bones.  Chondrocytes do not replicate, cannot repair  themselves when injured, and also decrease in number as the aging process progresses.  The  damaged or lost chondrocytes then fail to support the articular cartilage regeneration process  and articular cartilage defects occur.  Articular restoration procedures either enable the  surgeon to stimulate a healing response or replace the worn tissue completely.

Osteochondral Autograft (OATS)

This technique is analogous to a hair-plug transfer. The surgeon removes a small section of the  patient’s own cartilage along with the underlying bone plug. This is obtained from an area  which does not participate in high loading.

OSTEOCHONDRAL AUTOGRAFT example from syracuse orthopedic specialists

This bone and cartilage (hence osteo—chondral) local graft is then transferred to the defect  where a receiving hole has been prepared. Obviously, there is a limit to the amount of tissue  available for “harvesting.” The typical site of harvest is at the margin of the femoral  trochlea where the patella glides—if that area is involved with damage then this technique  may not be possible. The size of the defect treatable with this method is usually between  1 and 2 square cm or slightly larger than a thumbnail.

Autologous Cartilage Cell Implantation

For articular cartilage defects greater than 2cm2, one of the more advanced techniques for  cartilage regeneration is ACI (Autologous Chondrocyte Implantation).

The first stage may be performed when initially assessing the joint arthroscopically.  A small amount of the patient’s own articular cartilage is harvested. Through cell culturing  techniques, the cell number is increased from a few hundred thousand to over 10 million cells.  These autologous (your own) cultured cells are then implanted in the knee in a second  surgical procedure to repair and resurface areas of cartilage loss. The cells (the marshmallows) represent only 1-5% of the volume of the matrix (jello).  These cells must synthesize (create) matrix over several months to reestablish the articular  surface.

AUTOLOGOUS CARTILAGE CELL IMPLANTATION example from syracuse orthopedic specialists

Ligament Restoration

Ligaments connect bones and stabilize their position.  Loss of ligament function results in  instability.  The instability causes multiple problems including loss of functionality as  well as an abnormal stress load on the cartilage, furthering the damage.  Ligaments that do  not heal may require reconstruction.  The most recognized sports-related ligament  reconstruction is anterior cruciate ligament reconstruction (ACL reconstruction) to prevent  lateral direction change knee instability.  The goal for the surgical intervention is  always to reproduce the natural ligament function to the extent possible.


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