At California Pacific Orthopaedics, we are dedicated to providing our patients in the San Francisco Bay Area with the most advanced and effective treatments for joint pain and injuries. One of the most common causes of joint pain is damage to the articular cartilage, the smooth, white tissue that covers the ends of your bones and allows for easy, pain-free movement. When this cartilage is damaged, it can lead to pain, stiffness, and a significant decrease in your quality of life. Fortunately, there are a number of innovative procedures that can help restore damaged cartilage and get you back to the activities you love. This is a field of medicine known as cartilage restoration.
Overview
Cartilage restoration is a set of surgical procedures designed to repair or replace damaged articular cartilage. Unlike many other tissues in your body, cartilage has a very limited ability to heal itself. This is because it does not have its own blood supply. Once it’s damaged, it’s gone for good, and the damage can worsen over time, potentially leading to osteoarthritis. Cartilage restoration procedures aim to stimulate the growth of new cartilage, or to replace the damaged cartilage with healthy tissue. The goal is to relieve pain, improve function, and delay or prevent the need for a total joint replacement.
These procedures are most common in the knee, but can also be performed on other joints, such as the shoulder, ankle, and hip. The best candidates for cartilage restoration are typically younger, more active individuals with a single, isolated area of cartilage damage. Your doctor at California Pacific Orthopaedics will perform a thorough evaluation, including a physical exam and imaging studies like an MRI, to determine if you are a good candidate for one of these procedures.
Common Symptoms and Causes of Cartilage Damage
Damage to the articular cartilage can be caused by a sudden, traumatic injury, or by repetitive wear and tear over time.
Common Symptoms:
- Pain: This is the most common symptom, and it may be worse during or after activity.
- Swelling: The joint may swell, a condition known as an effusion.
- Stiffness: You may have difficulty bending or straightening the joint.
- Locking or catching: The joint may feel like it is “catching” or “locking” with certain movements.
- Instability: You may feel like the joint is giving way.
Common Causes:
- Traumatic injury: A direct blow to the joint, a fall, or a sports injury can cause the cartilage to tear or break off.
- Repetitive stress: Overuse of the joint, such as from running or jumping, can cause the cartilage to wear down over time.
- Instability: If the ligaments in your joint are loose, it can cause the bones to move abnormally, leading to cartilage damage.
- Osteochondritis dissecans (OCD): In this condition, a small piece of bone and cartilage separates from the end of the bone.
Common Risk Factors
Certain factors can increase your risk of developing cartilage damage:
- Age: While cartilage restoration is often performed on younger patients, the risk of cartilage damage increases with age.
- Obesity: Excess weight puts more stress on your joints, particularly your knees.
- Genetics: Some people may be genetically predisposed to developing cartilage problems.
- Previous joint injury: If you have had a previous injury to a joint, such as a ligament tear, you are at higher risk of developing cartilage damage.
- Certain medical conditions: Conditions like rheumatoid arthritis and hemochromatosis can also increase your risk.
Why is a Cartilage Restoration Procedure Done?
A cartilage restoration procedure is done to relieve the pain and disability associated with cartilage damage. The goals of the procedure are to:
- Restore the smooth surface of the joint: This allows the bones to move smoothly against each other, reducing pain and friction.
- Slow the progression of osteoarthritis: By repairing the damaged cartilage, it may be possible to slow down the degenerative process of osteoarthritis.
- Delay or prevent the need for a total joint replacement: For younger, more active patients, a cartilage restoration procedure can be a good alternative to a total joint replacement.
What to Expect: Before, During, and After the Procedure
The specifics of your procedure and recovery will depend on the type of cartilage restoration procedure you have. Your surgeon at California Pacific Orthopaedics will discuss the details of your procedure with you in advance.
Before the Procedure:
- Evaluation: You will have a thorough evaluation with your surgeon, including a physical exam and imaging studies.
- Pre-operative instructions: You will be given specific instructions to follow before your surgery, such as not eating or drinking after midnight the night before.
- Anesthesia: You will meet with an anesthesiologist to discuss the type of anesthesia that will be used.
During the Procedure:
- Most cartilage restoration procedures are performed arthroscopically, which means that the surgeon makes several small incisions around the joint and uses a small camera, called an arthroscope, to see inside the joint.
- The surgeon will then use specialized instruments to perform the procedure. There are several different types of cartilage restoration procedures, including:
- Microfracture: The surgeon creates small holes in the bone underlying the cartilage to stimulate the growth of new cartilage.
- Osteochondral Autograft Transplantation (OATS): The surgeon takes a plug of healthy cartilage and bone from a non-weight-bearing area of your joint and transplants it to the damaged area.
- Autologous Chondrocyte Implantation (ACI): This is a two-step procedure. In the first step, the surgeon takes a small sample of your cartilage cells. These cells are then sent to a lab where they are grown for several weeks. In the second step, the surgeon implants the new cartilage cells into the damaged area.
After the Procedure:
- Recovery: Your recovery will depend on the type of procedure you have. You will likely need to use crutches for several weeks to keep weight off of your joint.
- Physical therapy: Physical therapy is a very important part of your recovery. A physical therapist will teach you exercises to help you regain your strength, range of motion, and function.
- Return to activity: It may take several months to a year to fully recover and return to your normal activities. Your surgeon will give you specific guidelines on when you can return to sports and other high-impact activities.
