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 MAY 28, 2003 Your Cartilage and How to Save It If like New York Mets' first baseman Mo Vaughn you have severe knee arthritis and are told you need a knee replacement, several viable solutions to regenerate cartilage may help before you submit to a joint replacement. Making Tiny Holes If you have healthy joints and a small, localized cartilage defect, a microfracture procedure may be your best bet. This technique involves clearing damaged tissue from the joint through an arthroscope and creating tiny holes, or "microfractures," in the bone area where the cartilage is defective. The underlying bone marrow seeps out through the holes and becomes part of a blood clot that forms over the area. The marrow forms replacement cartilage; however, this cartilage is not as durable as hyaline, or natural, cartilage, says John Bergfeld, MD, Director, Cleveland Clinic Sports Health. Rehabilitation after surgery entails 6-8 weeks of non-weight bearing using crutches, along with the use of Continuous Passive Motion (CPM), where the joint is moved gently by a machine once every five seconds for 6-8 hours a day. Then you go through another 6-8 weeks of only partial weight bearing on the joint. Regrow Your Own Cartilage It's now possible to regrow your own cartilage with an autologous (which means self) cartilage implant, also known as the Carticel procedure. This procedure starts by removing a raisin-sized biopsy of healthy knee cartilage through an arthroscope. The biopsy is sent to a special laboratory that grows millions of new cells for your own cartilage cells. Then the news cells are implanted into the cartilage defect in a second surgery. During this surgery, a small piece of the periosteum, the tissue covering a bone, is taken from the lower leg and sutured over the defect like a patch to hold the cells in place. The cultured cells are then implanted under the periosteum to fill in the defect. "The best we can get with this is hyaline-like cartilage, not true cartilage," says Dr. Bergfeld. Most patients are back to full weight bearing within 6-8 weeks and resume physical activities within one year. Cartilage Plugs A Mosaicplasty, or osteochondral grafting, replaces weak or torn cartilage with healthy cartilage from the leg bone. During the procedure, healthy cartilage attached to the bone is inserted as tiny cylindrical plugs around the joint. First, the surgeon bores out holes where the defect is and then puts in a mosaic of 4-6 plugs (hence the name). By moving cartilage from non-weight bearing to weight bearing areas, Mosaicplasty can restore the shock absorption and fluidity of the joint. True hyaline cartilage is transferred, all in one step. Rehabilitation again takes 6-8 weeks with no weight bearing on the repaired joint. CPM may also be prescribed. Both cartilage transfer techniques have an 85% success rate in young (under age 40) patients with traumatic arthritis due to an injury. "Mosaicplasty is limited by the amount of healthy bone and cartilage we can take. Carticel can be used on larger cartilage defects," says Dr. Bergfeld. Unfortunately, "most patients sent for cartilage transplants are in their 60s with worn-out joints from osteoarthritis. Their bodies won't support cartilage growth as well as younger patients," he says. "They may be better off using medications to treat arthritis symptoms and maintaining their physical conditioning." |
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