The cartilage in the knees is divided into two categories: meniscus and articular cartilage. Articular cartilage allows the knee to move freely. Meniscus cartilage acts as a shock-absorbing cushion between the bones.
Injuries, accidents and normal wear can cause cartilage to be damaged in both knee types. It is then necessary to replace or repair the cartilage. Osteoarthritis is the result of cartilage wear.
The advances in orthopedic medicine have provided many options to treat knee injuries. Some of the more traditional approaches include knee joint replacement or surgery to repair torn tissue. There are also minimally-invasive treatments that use cartilage from other parts of the body, or cells from a patient’s own body.
This article reviews the traditional and newer approaches to knee cartilage repair and replacement.
1. Physical Therapy
You may be able, if the symptoms and loss of cartilage in your knee are mild, to delay surgery or other interventions by using physical therapy.
Physical therapy aims to increase the strength and flexibility around the knee joint in order to reduce the pressure on it. According to a 2018 study by Trusted Source, physical therapy can help reduce pain not only in mild knee osteoarthritis but also in moderate cases.
Physical therapy is not as beneficial for those with severe arthritis. The intensity of pain could be a factor to consider when deciding whether or not physical therapy should be pursued as a form of treatment.
According to a separate study published in Seminars in Arthritis & Rheumatism Trusted Source, weight loss through diet and exercise can help reduce knee arthritis symptoms in overweight and obese people.
A 2005 study by Trusted Source showed that a 1 pound weight loss can remove 4 pounds of joint pressure in knee osteoarthritis patients. If a person drops 5 pounds, it’s equivalent to removing 20 pounds from the knee joint.
2. Microfracture
Microfracture is one way to stimulate cartilage growth. This procedure involves drilling tiny holes in the bones of the knee joint in order to increase blood flow and release cells that produce new cartilage.
The best people for microfracture are:
- Under the age of 40
- Recent knee injuries
- Lesions are small areas of cartilage degeneration.
It is not recommended that older adults with severe arthritis or large lesions undergo microfracture.
You’ll have to use the continuous passive motion machine (CPM) several hours per day for bending and straightening your knee. It may take 9 months to resume sports or other strenuous activity.
Microfracture surgery costs around $4,000 and is therefore less expensive than other knee repairs.
A relatively low incidence of infection or other complications is another advantage of microfracture. In some cases the procedure doesn’t produce enough cartilage replacement, so another treatment might be required in the future.
3. Resurfacing Of Cartilage Using Cells
The procedure for growing new cartilage is also called matrix-induced autologous (MACI). It involves two steps. The procedure begins with an arthroscopic knee cartilage biopsy. The cartilage cells in the biopsy tissue are then manipulated in a laboratory to begin growing. The surgeon will shape the cartilage to fit the natural cartilage to be replaced when it is ready for implant.
MACI is looking for candidates who have:
- You are young and you have good regeneration ability
- Have symptoms of cartilage injury
- Have small, isolated lesions smaller than the size a dime
According to a 2015 study by Trusted Source, MACI is an effective and safe method of cartilage replacement in the majority of people.
MACI is typically an outpatient procedure. You can expect to wear your knee brace for 6 weeks as you regain strength and stability. MACI costs around $40,000. Most of these costs are covered by insurance.
The MACI procedure has a number of downsides, including the cost, and the fact that it requires two separate surgeries. There is also the risk of cartilage growth, which may require a third operation.
MACI is a treatment that can be used to repair small cartilage areas. It also uses the patient’s own cells which reduces the chance of rejection.
4. Osteochondral autograft
This surgery, also known as a mosaicplasty or a cartilage replacement surgery, uses cartilage taken from another part of the knee to replace cartilage which has been worn down significantly. Another procedure called osteochondral alograft is performed using donor tissue.
During this procedure, the surgeon will remove the damaged cartilage as well as a small portion of the bone beneath. Imagine the core of an apple. A replacement “core” made from bone and cartilage taken from another part or donor knee is then used to fill the hole. In most cases, screws or mechanical devices do not need to be used to fix the replacement tissue.
As with other knee procedures an osteochondral allograft or autograft will require about 4 to 6 week of recovery time before the knee is able to start bearing weight. After a few months of rehabilitation, you should be able to return to your normal activities or sports.
Allografts can cost up to $10,000. The limited availability of tissue donors and the possibility that the body will reject the implant are also downsides.
Allografts are usually more expensive than autografts, but autografts tend to be less costly and carry a lower risk of complications. According to research, autografts are likely to provide satisfactory results for at least 10 year among 72 percent of those who undergo this procedure.
Candidates for this procedure are best suited to be young, as they have more regenerative cells for the graft. Allografts are also used to repair cartilage worn areas that are smaller than a penny.
Autografts are more invasive because they require the removal of healthy tissue from another part of the body. Many people do not want to take the small risk of complications arising from the removal of healthy bone and cartilage.
5. Knee Replacement
If other less-invasive treatments have not improved the pain and mobility of your knees, you may need a knee replacement.
Incisions are made above the knee and down to the joint. The damaged knee joint can be removed in whole or in part, and then replaced with a knee prosthesis that mimics the function and movement of a normal knee.
Metal, ceramic, or plastic materials are used to resurface the worn-out surfaces of the knee that were previously covered with cartilage. This provides new surfaces for gliding.
Knee replacement surgery costs can range from $19,000 up to $50,000, depending on factors such as the type of surgery performed, the hospital and the other factors. It’s important to talk with your insurer about the costs and make sure you know exactly what will be covered.
Physical therapy can help most people return to normal activities in 6 weeks. However, a complete recovery may take months. Knee replacements can restore the full function of your knee joint, and can relieve the pain which can make standing or walking difficult.
Robotic surgery is being used by special centers such as Yale University to improve component placement, biomechanics and quality of motion for knee replacement operations.
Knee replacement surgery is no different. It can carry the same risk of infection and other complications. The knee is a complex joint and the prosthetic may not meet your expectations. You may have to decide whether to undergo a second surgery or to adjust to your new knee.
Knee Cartilage Replacement Has Many Benefits
When the cartilage in the knee is severely damaged or worn out, it can cause pain every day and reduce mobility. This condition will not improve by itself.
The cartilage in the knee can be repaired or replaced.
- Pain relief
- Improve knee function
- Prevent or delay osteoarthritis and other complications
Speak To Your Doctor About The Best Procedure For You
Talk to your doctor if you are experiencing knee pain. You can be referred to a physical therapy or orthopedist that specializes in knee care. Surgery is not always the solution, but for severe cartilage injury, it is possible.
The best approach for you will be determined by your age and level of activity. Another factor is the nature and severity your knee problem.
Speak to your doctor about the recovery period and procedures involved. You should also ask about the cost of a particular procedure and what percentage of it will be covered by insurance.
No matter which treatment you choose for your knee cartilage, you will need to be ready for a long recovery and rehab phase. According to a study published in World Journal of Orthopedics Trusted Source, rehabilitation is essential for the success of any cartilage resurfacing surgery.
