What is Knee Cartilage Repair?
Knee cartilage plays a vital role in the proper functioning of the knee joint. Cartilage is a smooth, rubbery tissue that covers the ends of the bones in a joint, allowing them to move smoothly over each other. In the knee, there are two types of cartilage: articular cartilage and meniscus cartilage.
- Articular cartilage covers the surfaces of the bones where they meet in the knee joint and allows for smooth, frictionless movement.
- The meniscus is a C-shaped piece of cartilage between the femur (thigh bone) and tibia (shin bone) that absorbs shock and stabilizes the knee.
When the cartilage is damaged due to injury, wear and tear, or degenerative conditions like osteoarthritis, it can lead to knee pain, swelling, instability, and difficulty moving the joint. Knee cartilage repair is a surgical procedure used to treat damaged cartilage, restore joint function, and reduce pain. The type of cartilage repair depends on the location and severity of the cartilage injury.
Why is Knee Cartilage Repair Needed?
Knee cartilage damage can occur from:
- Trauma or injury, such as a fall, car accident, or sports-related injury (e.g., twisting the knee during an activity).
- Degenerative changes, such as osteoarthritis, which gradually wear down the cartilage over time.
- Repetitive stress or overuse, especially in athletes or individuals who engage in high-impact activities.
When the cartilage is damaged, it can cause symptoms like:
- Knee pain, especially when bending, squatting, or bearing weight.
- Swelling and inflammation in the knee.
- Instability or the feeling that the knee is “giving way.”
- Limited range of motion, making it difficult to walk, run, or perform daily activities.
Knee cartilage repair is typically considered when conservative treatments (rest, physical therapy, medications) are no longer effective, and the cartilage damage is significant enough to affect knee function.
How is Knee Cartilage Repair Performed?
Knee cartilage repair can be done using different surgical techniques, depending on the type of cartilage damage and the location of the injury. The repair may involve minimally invasive arthroscopic surgery or open surgery, depending on the severity and extent of the damage.
Types of Knee Cartilage Repair Procedures:
- Arthroscopic Debridement:
- What it is: A minimally invasive procedure where the surgeon uses small incisions and an arthroscope (a small camera) to view and clean the damaged cartilage. The goal is to remove any damaged tissue and smooth the surface of the cartilage to promote healing.
- Best for: Minor cartilage damage or early-stage cartilage degeneration.
- Microfracture Surgery:
- What it is: Involves creating tiny holes in the bone beneath the damaged cartilage (the subchondral bone) to stimulate the growth of new cartilage. This technique encourages the body’s natural healing process to form a fibrocartilage (scar tissue) that helps repair the damaged area.
- Best for: Small to medium-sized cartilage defects, particularly in younger patients with localized damage.
- Autologous Chondrocyte Implantation (ACI):
- What it is: A two-step procedure where healthy cartilage cells are taken from a non-weight-bearing area of the knee, cultured in a lab to grow new cartilage cells, and then implanted into the damaged area of the joint.
- Best for: Larger cartilage defects or more advanced cartilage damage.
- Osteochondral Autograft Transplantation (OAT):
- What it is: Healthy cartilage and bone are taken from a non-weight-bearing area of the knee and transplanted into the damaged area. This procedure helps restore the cartilage and underlying bone structure.
- Best for: Larger defects where microfracture may not be suitable.
- Osteochondral Allograft Transplantation:
- What it is: Similar to OAT, but instead of using the patient’s own tissue, donor cartilage and bone from a cadaver are used to fill the defect.
- Best for: Large or deep cartilage defects, particularly in older patients with more extensive damage.
Procedure Steps for Arthroscopic Cartilage Repair:
- Anesthesia: The surgery is usually performed under general anesthesia or regional anesthesia (spinal or epidural) to numb the lower half of the body.
- Incisions: The surgeon makes small incisions around the knee to insert an arthroscope and specialized surgical tools. The arthroscope provides a clear view of the cartilage damage on a monitor.
- Repair: Depending on the technique used, the surgeon will either remove damaged tissue (debridement), stimulate the bone to promote healing (microfracture), or transplant healthy tissue (OAT or ACI).
- Closure: Once the repair is complete, the incisions are closed with sutures, and the knee is bandaged.
The procedure typically takes 1-2 hours, depending on the extent of the damage and the surgical method used.
Post-Surgery Care and Recovery:
Immediate Post-Surgery (First Few Days):
- Pain and Swelling: It’s normal to experience some pain, swelling, and bruising in the knee after surgery. Ice and prescribed pain medications can help manage these symptoms.
- Rest and Elevation: Resting and elevating the knee is important to reduce swelling and promote healing.
- Bandages and Wound Care: Keep the surgical site clean and dry. Follow your surgeon’s instructions for changing bandages and caring for the incision sites.
Rehabilitation (Physical Therapy):
Rehabilitation is essential to restore knee strength, mobility, and function after surgery. The intensity and duration of physical therapy vary depending on the type of cartilage repair performed.
- Phase 1 (0-6 weeks): Focus on reducing swelling and pain, and gently restoring range of motion. Weight-bearing is usually limited during this phase, and crutches or a brace may be used.
- Phase 2 (6-12 weeks): As healing progresses, physical therapy will involve strengthening exercises for the quadriceps and hamstrings, as well as improving balance and flexibility.
- Phase 3 (3-6 months): More intense strengthening exercises will help rebuild the muscles around the knee. Low-impact activities like cycling or swimming may be allowed, depending on your progress.
- Phase 4 (6-12 months): For many patients, full recovery occurs in 6-12 months, although the timeline may vary. High-impact activities like running or jumping may be reintroduced gradually after clearance from your surgeon.
Long-Term Recovery:
It may take 6-12 months for full recovery, depending on the size and location of the cartilage defect and the technique used. Some patients may experience improvements in knee pain and function sooner, while others may require a longer rehabilitation period.
Potential Risks and Complications:
As with any surgery, there are risks, although complications are rare:
- Infection: There is always a risk of infection with any surgical procedure. Signs of infection include fever, redness, swelling, or drainage from the incision sites.
- Blood Clots: Patients may be at risk for developing blood clots in the leg (deep vein thrombosis). Mobilizing early after surgery, as instructed by your surgeon, can help prevent this.
- Knee Stiffness: Some patients may experience stiffness in the knee, which can be improved with physical therapy.
- Cartilage Failure: In some cases, the repair may not fully heal, and additional surgery may be required.
- Re-injury: The repaired cartilage may be vulnerable to further damage, particularly if high-impact or repetitive activities are resumed too soon.
Benefits of Knee Cartilage Repair:
- Pain Relief: One of the main benefits is the reduction in knee pain, allowing you to return to daily activities with less discomfort.
- Preservation of Joint Function: Repairing damaged cartilage can restore knee function and improve stability.
- Minimally Invasive Options: Some cartilage repair procedures (e.g., arthroscopic debridement and microfracture) are minimally invasive, meaning they involve smaller incisions, less trauma to the surrounding tissue, and faster recovery.
- Prevention of Further Damage: Repairing damaged cartilage can help prevent the progression of arthritis or further damage to the knee joint.
Long-Term Outlook:
Most patients experience good to excellent outcomes after knee cartilage repair. While full recovery may take several months, many individuals can return to low-impact activities like walking, swimming, and cycling within a few months. Those involved in high-impact sports may need to wait 6-12 months before resuming their normal activities.
The success of the procedure depends on the size and location of the cartilage defect, the surgical technique used, and adherence to post-surgery rehabilitation.
When to Contact Your Surgeon:
You should contact your surgeon if you experience:
- Signs of infection, such as fever, redness, or swelling at the incision sites.
- Severe or persistent pain that does not improve with medication or rest.
- Excessive swelling or bruising that does not subside after a few days.
- Inability to move your knee or feel unstable.
Conclusion:
Knee cartilage repair is an effective solution for restoring joint function, reducing pain, and improving mobility in individuals with cartilage damage If you suffer from cartilage injuries, we would be happy to take care of you.