Articular Cartilage

July 7, 2009 at 9:26 pm (Life) (, , )

So, my appointment with the Orthopedic Surgeon isn’t for another 9 days.  But in the meantime, I’ve been reading up on the four ways to repair the articular cartilage.  A lot of it will depend on the size of the legion (the MRI pictures are sitting right here, but unfortunately I’m no radiologist so to me they are nothing more than interesting pictures taunting me with information I can’t access until next week), but any way these are the options.

Arthroscopic Lavage and Debridement

This procedure is arthroscopic (did you guess that?), so the recovery time is only a couple weeks (about 2 weeks until full weight bearing, 8 weeks total recovery).  It is used for defects less than 1 cm.  Basically, they go in and trim and clean out the damaged area.  It is essentially the procedure I’ve had twice already.  And double blind studies have shown no difference between this and a placebo.  Additionally, there is some evident that it speeds the cartilage degeneration, and thus arthritis, that is often seen in aging.

Marrow Stimulation / Microfracture

This procedure is used for defects up to 2 cm.  It can also be and arthroscopic procedure, but recovery is a bit longer; 6-8 weeks of no weight bearing, and 6 months rehab).  The damage portion of the cartilage is removed and than the bone is drilled into 2-4mm.  Not liking this, the bone develops a blood clot which slowly turns into fibrocartilage that fills in the area of missing cartilage.  The fibrocartilage typically wears away in 1-2 years; for this reason this procedure is typically seen as an intermediate step.

Osteochondral Autografts and Allografts

This procedure is done via arthrotomy.  Again, 6-8 weeks non-weight bearing, 7 months rehab.  In the Autograft, a portion of the non-weight bearing cartilage is cut away and used to patch the damaged area.  Because of the way the cartilage is harvested, this procedure is effective for defects less than 4 cm.  However because the cartilage is taken from within the joint, donor site morbidity (and new problems may occur).  The Allograft is basically  the same except the cartilage is taken from a cadaver donor.  And that is just nasty.  Plus, it brings the added risks of transplants and apparently cartilage donors can be hard to find.

Autologous Chondrocyte Implantation

This is a two part procedure.  So, in the first part, a small sample of cartilage is taken from a non-weight bearing portion of the femur (this part is arthroscopic).  These cells are then cloned in a lab, a process which takes about 6 weeks.  The second procedure (arthrotomy this time) takes these cells and implants them in the damaged area.  Recovery involves 6-8 weeks non weight bearing, and 7-24 months of rehab.

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2 Comments

  1. Justin Parreno said,

    Hello.. I am just curious which one you went with? I am doing my PhD in cartilage regeneration and we are trying to develop some autologous chondrocyte implants.

    • Jessica said,

      Fortunately none of the above.
      I had am arthroscopic Lateral Retinacular Release in January. And have since fully recovered. If you have additional questions, feel free to contact me a jlsmith (at) prescott (dot) edu

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