Treatments of biologic origin are best when treating knee disease or injury. This type of treatment can restore the knee to a near-normal state. Reconstruction of the ACL (anterior cruciate ligament), meniscal repair, and anatomic knee fracture repair are three kinds of biological surgical repairs that have good success with knee injuries.
Patients and orthopedists often have problems managing a full-thickness, symptomatic chondral lesion of the knee.
Injury that leads to articular cartilage cell death is well treated by restoration of the surface cells of the joint. The shiny white surface that composes all the joints in the body is the articular cartilage or surface cell layer of the joint.
Four separate treatment options are possible: Osteochondral Allograft, Microfracture, Osteoarticular transfer system (OATS), and Autologous Chondrocyte Implantation (ACI).
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In a young patient, a small lesion can be treated with Microfracture surgery. In this method, a pick-like tool is used to enter the marrow of the knee under the chondral defect. Multiple entries stimulate the bone marrow, which, in turn creates repair tissue. This tissue fills the chondral defect with fibrous cartilage tissue.
In this scenario, the patient will be on crutches for a month to eight weeks. The patient must not participate in sports for a six months to year. Additionally, the patient must realize that it may take up to eighteen months to be completely pain free.
It is possible to restore the knee surface to a near-normal condition with a procedure called autologous chondrocyte implantation (ACI). This procedure is used if the knee defect is large.
ACI uses articular cartilage cells that have been harvested from the healthy part of the injured knee. There are strict indications and use criteria in place where cartilage restoration procedures are concerned.
Here are the surgical indications for ACI. First, the injury must be a full-thickness, symptomatic, weight-bearing chondral injury of the femoral articular surface. Second, the patient must be physiologically young. Third, the patient must agree to cooperate with the rehabilitation process for eighteen months.
There is no guarantee of successful surgery to the tibia and patella. In fact, insurance companies will often refuse to pay for this type of surgery. It is important to note that ACI is not a workable procedure for the treatment of osteoarthritis. In this condition, two reciprocal joint surfaces experience damage. X-rays will reveal narrowing of the joint space. Additionally, bone spurs will be in evidence. 3T MRI (magnetic resonance imaging) may be used to assess for ACI. By using this procedure, the proper treatment can be determined.
Click here for more on Dr. Stefan Tarlow, an expert Phoenix surgeon of the knee.
