Knee Cartilage Damage Repair and Replacement

Cartilage is a smooth and resilient type of connective tissue in your body. At the joints, it shields and covers the ends of your lengthy bones. Cartilage does not contain nerves or blood vessels.

Knees contain 2 types of cartilage: Meniscus and Articular. Articular cartilage helps the knee move freely. Meniscus cartilage serves as a shock absorber or cushion between the bones. Years of normal wear and tear, accidents and sports injuries can damage both types of cartilage in the knee, making it necessary to replace or repair the lost cartilage. Osteoarthritis is a condition where the cartilage begins to wear down. 

In this blog, we review newly emerging and traditional approaches to knee cartilage repair and replacement.

What are the Various Options for the Repair and Replacement of Knee Cartilage?

Thanks to advancements in orthopaedic surgery, there are several alternatives for treating knee problems. Some traditional methods include knee joint replacement or surgery to restore broken cartilage. In addition to this, there are currently minimally invasive (keyhole) procedures that use cartilage harvested from other parts of the body or tissue grown from a patient’s cells.

The several options for the replacement and repair of knee cartilage are:

1. Physical Therapy

If the loss of knee cartilage and symptoms are minor, you might be able to put off surgery or other interventions through physical therapy.

Physical therapy’s primary objective is to increase the knee joint’s surrounding muscles’ range of motion and strength to lessen the strain on the joint itself. Physical therapy helped reduce pain, not just in cases of mild knee osteoarthritis, but in people dealing with moderate pain, too. 

Physical therapy had less of an impact on persons with severe arthritis pain, suggesting that pain severity may be a key consideration when determining whether to seek physical therapy as a therapeutic option.

Weight loss achieved through diet and exercise can often help ease knee arthritis symptoms in people who are overweight or obese. 

2. Microfracture

Microfracture is one method of stimulating the creation of new cartilage. To promote better blood flow and the release of cells that build new cartilage, small holes are drilled in one or more of the knee joint’s bones.

Microfracture is best suited for people who:

• Have lesions (small areas of cartilage degradation) 
• Have experienced recent knee injuries
• Are under the age of 40

For elderly people with severe osteoarthritis or to treat extensive lesions, microfracture is not advised. 

After the procedure, you will need to keep weight off your knee for about six weeks and use a CPM (continuous passive motion) machine several hours a day to straighten and bend the knee. Resuming sports or other strenuous activities might take up to nine months.

The comparatively low incidence of infections or other problems following microfracture surgery is an additional benefit. However, occasionally the operation does not produce enough new cartilage, necessitating the potential long-term need for a different kind of therapy.

3. Cell-based cartilage resurfacing

This procedure to grow new cartilage, also known as MACI (matrix-induced autologous chondrocyte implantation), is a two-step process. An arthroscopic cartilage biopsy of the knee is the first step. The cartilage cells from the biopsy tissue are then stimulated to begin growing in a lab. When the fresh cartilage is ready for implantation, the surgeon cuts and moulds it to suit the missing piece of natural cartilage.

The following individuals are the best MACI candidates:

• Have tiny, discrete lesions that are a little larger than a dime
• Have symptomatic cartilage injuries
• Are young and have a good regenerative ability

MACI is an effective and safe approach to cartilage replacement for most people.

MACI is typically an outpatient procedure, though you can expect to wear a knee brace for about six weeks while your knee regains stability and strength. 

Aside from the need for 2 separate operations, the other main downside to MACI is that there is a risk of cartilage overgrowth, which can require a third surgery to treat.

The main justifications for MACI are that it works well for repairing tiny patches of cartilage and that it makes use of the patient’s cells, lowering the likelihood of rejection by the body.

4. Osteochondral autograft

This procedure, also known as a mosaicplasty, substitutes worn-out cartilage for good cartilage from another area of the knee. Osteochondral allograft, a similar surgery, uses donor tissue.

During the procedure, a surgeon removes the damaged cartilage and a portion of the underlying bone. The hole is then filled up with a replacement core consisting of bone and cartilage from another section of the body or a donor’s knee. Typically, no screws or other mechanical fasteners are required to hold the new tissue in place.

Like other knee procedures, an allograft or an osteochondral autograft requires about four to six weeks of recovery before the knee can start to bear weight. With the help of rehabilitation, a complete return to sports or other activities should be possible within six to nine months.

There are some downsides, which include the limited availability of donor tissue and the risk that the body may reject the implant.

The rehabilitation period is typically longer with an allograft than with an autograft, and an autograft is normally less expensive and carries a smaller risk of complications. Research suggests that autografts provide satisfactory outcomes for at least ten years among 72% of people who undergo the procedure.

Young people are the best candidates for this treatment since they have more regenerative cells available for transplant. In addition, an allograft is usually used to repair areas of worn cartilage that are no larger than a dime.

However, an autograft is a more invasive surgical treatment since it requires the removal of healthy tissue from another part of the body. Additionally, some people are reluctant to take the risk – even a small one – of issues arising from the removal of healthy bone and cartilage. 

You Can Also Read: Cracking of Bones and Joints

5. Knee replacement

When other less invasive approaches have not improved knee pain and movement, severe knee arthritis might require a knee replacement.

The procedure begins with an incision from above the knee down past the knee joint. All or part of the damaged knee joint is then removed and replaced with a prosthetic knee joint that duplicates the movement and function of a natural knee.

To create new gliding surfaces, worn-out knee surfaces that were once covered in cartilage are also resurfaced with ceramic, plastic, and metal materials. 

By participating in physical therapy following the operation, most people can resume everyday activities within six weeks, though a full recovery can take several months. On the bright side, knee replacement can ultimately give your knee joint full functionality again and eliminate the discomfort that might make standing or even walking uncomfortable.

As with any surgery, knee replacement carries the potential risk of infection or other complications. Because the knee is a complicated joint, there is a chance that the prosthetic knee might not completely meet your expectations. As a result, you might need to consider a second operation or adjust to life with the new knee as it is.

What Are the Benefits of Knee Cartilage Replacement?

Knee cartilage can get significantly worn down or damaged to the point that it no longer offers cushioning between the bones or smooth bone movement inside the joint, which can result in decreased mobility and ongoing discomfort. It is not a condition that will improve on its own.

Replacing or repairing damaged knee cartilage can:

• Prevent or delay osteoarthritis or other complications
• Improve knee function
• Provide pain relief

Also Watch: Cauda Equina Syndrome treated by Endoscopic Spine Surgery

Conclusion

Damaged knee cartilage can either be repaired or replaced as per your existing condition. It is always advisable to seek medical help from an experienced orthopaedist. Timely care and help can ensure an appropriate diagnosis and treatment of your condition. 

At the CK Birla Hospital, we ensure patients get holistic medical support which includes treatment in a compassionate environment. This patient-centric approach not only helps patients heal better but also ensures they are aware of the preventive measures as well. In case you need to consult an orthopaedist, reach out to us, or book a direct appointment with Dr.Reetadyuti Mukhopadhyay at the CK Birla Hospital.

FAQs

Can You Walk With Damaged Knee Cartilage?

With knee cartilage injuries, locking and pain of the knee can lead to difficulty with running, walking and other activities. The most visible indicator of knee cartilage degradation is pain, but repeated knee swelling is also a common warning sign.

Can a Physiotherapist Help With Knee Cartilage Damage?

Most meniscal tears improve with physiotherapy and time. Physiotherapy will include load modification e.g. reducing your walking and running and reduction or avoidance of the activities and movements that make your swelling or pain worse.