Monday, June 1, 2009

Surgery of the Knee: Cartilage Restoration - Osteochondral Allograft, Microfracture, OATS, and ACI

By Dr. Stefan Tarlow

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.

A symptomatic full-thickness chondral lesion of the knee presents a problematic management issue for patients and orthopedists.

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.

This kind of tissue damage can be treated in four ways: Osteochondral Allograft, Autologous Chondrocyte Implantation (ACI), Osteoarticular transfer system (OATS), and Microfracture.

Click here for more on Arthroscopy of the Knee.

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.

The patient will use crutches for about 6 to 8 weeks. He or she must forgo sports for half a year to a year. It may take as much as 18 months for complete relief of pain to be achieved.

There is a procedure that can restore the knee surface to almost normal condition. This is called autologous chondrocyte implantation (ACI). This procedure is used in the case of large knee defects.

Articular cartilage cells can be harvested from the healthy part of the injured knee for utilization in ACI. There are very specific criteria that must be met for this surgery to be used.

The patient must have a full-thickness, weight-bearing, symptomatic chondral injury to the femoral articular surface. Additionally, the patient must be physiologically young. Furthermore, the patient must agree to an 18 month rehabilitation process.

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.

About the Author:

No comments:

Post a Comment