Articular cartilage can be damaged by a traumatic injury, progressive wear or systemic disease. Loss or erosion of articular cartilage causes pain, weakness and dysfunction. If left untreated, cartilage damage can progress and lead to symptomatic arthritis.
Cartilage has a poor capacity to repair itself. As a result, surgery may be necessary for individuals who present with joint (knee, ankle, hip, elbow) dysfunction associated with a painful cartilage or chondral lesion. Successful cartilage repair surgery reduces pain and restores function. There are numerous cartilage repair treatment options available, and the suitability of each of these approaches depends on each patient’s unique clinical problem. Physicians in the HSS Institute for Cartilage Repair are experts in the treatment of damaged articular cartilage. Their clinical approaches are data-driven and, consequently, our physicians note high clinical success rates in their respective patient populations.
In its simplest terms, cartilage repair (regeneration) surgery results in the formation of robust cartilage-like tissue around the joint where the cartilage has worn away or been damaged. Cartilage regeneration typically requires some sort of surgical intervention. Synthetic adjuncts are often needed to successfully regenerate articular cartilage. Adults don’t have the natural capability to grow new articular cartilage from scratch. This ability is only possible in a fetus growing inside the womb. This fact makes cartilage repair surgery challenging.
Our physicians will take a full medical history, perform a physical exam, and utilize imaging studies (X-rays, MRIs, CT scans) to determine the location and extent of the articular cartilage damage. Advanced MRI technology allows surgeons to design a personalized treatment plan prior to surgery. Continual MRI readings taken after surgery allow for an objective assessment of the performed surgery and the application of a proper rehabilitation plan that, together, facilitate a complete recovery.
No. Articular cartilage is the smooth cushion that lines the ends of bones where they meet at joints such as the knee, shoulder and ankle. Intact articular cartilage allows bones to move against one another without friction in healthy joints. Cartilage contains no nerves and does not have a full blood supply. As such, cartilage does not have the capacity to heal on its own.
Repair of one’s damaged existing cartilage cannot usually be performed. Yet, there are treatment options in which damaged articular cartilage may be replaced or reconstructed using cell-based or tissue-based strategies.
For example, one commonly performed procedure (mosaicplasty, osteochondral autograft transplant) works by taking small cylinders of cartilage from one area of a patient’s joint (typically a non-weightbearing area) to reconstruct and fill a cartilage defect in a weightbearing area. Another commonly performed procedure uses donated cartilage tissue (osteochondral allograft) to reconstruct large joint cartilage lesions. In yet another method, small arthroscopically harvested cartilage samples can be used to grow a customized cartilage “patch” that can be used to fill a cartilage defect. Surgeons at HSS have been performing these procedures since the 1990s and have been at the forefront of developing all of these described methodologies.
Cartilage repair surgery consists of regenerating or replacing cartilage, either with tissue from the patient’s own body, someone else’s body, or by generating cartilage repair tissue in a lab.
The ideal cartilage repair candidate is someone who suffers from an isolated articular cartilage defect. The patient should have a relatively healthy knee with no generalized cartilage loss (arthritis). The treated knee should be well-aligned and stable (no ligament deficiencies). Cartilage repair can be performed on people of all ages but, typically, patients are under 50 years of age.
Cartilage injuries that can be treated by cartilage repair surgery include:
Cartilage repair is most commonly used to treat isolated cartilage defects. Cartilage repair surgery is not performed to treat arthritis. However, cartilage repair surgery may help affected individuals delay or avoid a knee replacement. Cartilage repair may also be used to treat cartilage lesions of the ankle, elbow, shoulder or hip.
Due to recent medical advances, there are now multiple treatment options available depending on factors such as size of the cartilage damage and a patient’s end goals.
Most of the described surgical procedures take less than an hour. Surgeries can be performed arthroscopically but may require a small incision to fully execute the procedure. Combining the cartilage repair procedure with other surgeries (ligament reconstruction, osteotomy) may lengthen the procedure accordingly.
Most patients use crutches for the first two to three weeks after surgery. Physical therapy usually starts about a week after surgery on an outpatient basis. Most patients can return to normal activities of daily living four to six weeks after surgery. Many patients are cleared for some sports after six months. However, getting back to a high level of fitness or ballistic sports may take longer. Different surgical treatment options have different timetables for a return to high level activities. Osteochondral autograft and allograft patients usually can expect to be cleared at six months. In contrast, the MACI procedure, because this method requires two surgeries spaced six to eight weeks apart, the full recovery time is closer to 12 to 18 months.
Physical therapy is an important part of recovery and should be utilized as appropriate. Postoperative MRIs are used to assess the success of the procedure and show progress through the physical therapy process.
If you are looking to go back to heavy exercise or athletics, it is important to work with a strength and conditioning coach to help with training.
As a subspecialty, cartilage repair surgery has rapidly evolved since its inception in the late 1990s. Before that time, there were few treatment options available to address this clinical problem. Currently, there are multiple ways to treat cartilage damage. Success rates truly depend on several factors (surgery performed, patient age, body mass index, duration of symptoms etc.). Our surgeons have tracked their clinical outcomes in this area since 1998. The HSS Cartilage Registry tracks the clinical outcomes of over 4,000 patients who have been treated for symptomatic cartilage defects. Our surgeons recommend custom treatment options based on objective data and clinical outcomes.
There is no more risk involved than typical surgical risk.
Simply, no. In most cases, surgery is required to repair articular cartilage.
In rare cases, small traumatic cartilage lesions form a repair tissue called fibrocartilage on their own. This typically occurs at the time of injury if there is a significant amount of bleeding and trauma. Fibrocartilage is located between the vertebra of the spine, in the meniscus of the knee, and in joint capsules that surround some joints. Fibrocartilage is inferior to articular cartilage for the purposes of bearing loads in a joint.
Taking vitamins does not help cartilage to repair itself. However, there are supplements that can play a role in controlling and limiting joint inflammation that is associated with cartilage damage. Oral supplements such as glucosamine sulfate or hyaluronic acid can be helpful in relieving symptoms. Neither of these substances have been clinically proven to promote or result in the repair of damaged cartilage. It is our recommendation that it is best to consult with your physician before adding any supplements to your diet.
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Reviewed and edited by Riley J. Williams III, MD