People who need cartilage transplants are
those who have localized cartilage damage,
usually young people,
about half of them have had a traumatic episode,
the other half has some sort of underlying
factor that has led to cartilage breakdown.
And the local cartilage damage can be treated by
filling that area with cartilage.
More advanced widespread cartilage loss, as we see in
osteoarthritis, is not a good candidate for a cartilage transplant
and is better served with joint replacement.
So the goal of cartilage transplantation is to
fill an area of cartilage loss in the joint.
There are several different options for how to do this ranging from arthroscopic procedures,
to open procedures.
Options include microfracture, which is placing small holes in the bone
to allow marrow cells to fill the cartilage loss.
Transplantation of cartilage from one area of the joint
or from the knee joint, to another area.
Transplant of cadaveric cartilage from a donor.
Or transplantation of cells that are removed during an initial stage procedure,
grown in culture and then re-implanted into the area of cartilage loss
under a patch.
There are some newer available options for cartilage transplantation
involving donor cartilage that's been preserved
and placed into the area of cartilage loss with fibrin glue.
The results from that are still very preliminary, but it's
an exciting development in our field and we're really
excited about the potential utilization of this for more patients.
The most basic is a transplant of bone and cartilage from one area of the knee
to another area of the knee.
The knee is the most common joint that we do this in,
but you can do it in other joints as well or
even transplant from the knee
to another joint.
And what this is is essentially
playing a shell game
with the cartilage in the knee and moving cartilage that
you don't need it as much, to an area that you need it more.
And the bone heals the bone well and the cartilage goes on
living just as if it was in the same
location, it doesn't even know that it's been moved.
A more advanced cartilage transplant is to transplant living
cartilage from a donor.
So someone who is passed and
cartilage is harvested,
within two weeks
and is tested for every known disease and then
transplanted in the same fashion into an
area where it's needed.
I also perform autologous chondrocyte implantation,
which is a transplant of autologous cells.
That's a two-stage procedure,
where some normal cartilage is removed from the knee,
grown in culture by a company based in Boston.
And the cells in the tissue are isolated and expanded from a
few hundred thousand cells, to thirty to forty million cells.
And those cells are then re-implanted into the area where the cartilage is lost,
under a patch which is sewn into the surrounding cartilage
using absorbable sutures.
Those cells then grow and fill that area,
restoring the normal contour to the cartilage.
It's a long recovery because it starts off as a liquid and has to
slowly grow into a solid cartilage,
which is normally hard like plastic and that can take up to a year,
but that is currently the gold standard for
cartilage transplantation.
To restore cartilage using your own tissue.
In the future,
hopefully we'll have the option to inject cells or growth factors
to restore cartilage loss, without the need for surgery.
Unfortunately, that's many years or decades in the future.
Patients with cartilage problems,
depending upon the extent of the injury
and the success with initial treatments,
may need a specialist who's versed in all potential options
to obtain the best possible outcome for the problem.
Most general practitioners encounter cartilage
problems on a regular basis.
The majority of these are osteoarthritis, which is
widespread cartilage loss.
Younger patients with more localized cartilage
damage can be difficult to treat,
due to their high demands.
With the current technologies and options that we have
younger patients do the best with these treatments,
but age is just a number.
We treat patients of all ages and
the most important thing is the physiology,
so someone who is older by number but
physiologically young, may still be a candidate.
So there's no hard and fast age cutoff for any of these procedures.