Surgery & Cartilage - Introduction
Cartilage damage comes in many shapes and forms. Similarly, there are multiple surgical procedures that address articular cartilage damage. The specific procedure that a surgeon recommends is based on a number of variables, including the location of the cartilage lesion, the length, width and depth of the lesion, the stability of the joint and the alignment of the extremity. Surgeons take these factors and many others into account when developing an individualized plan for the surgical treatment of cartilage damage. For any given procedure, the indication and the outcome are inextricably linked. If the indication is correct, the predictability of a successful outcome is high. The opposite holds true if the indications for a given procedure are poor.
Debridement Chondroplasty and Lavage
This procedure involves smoothing out rough areas of cartilage wear and removing loose cartilage pieces. It does not replace cartilage in any way. It is often the first step in diagnosing the extent of, and treating, articular cartilage degeneration.
Marrow Stimulation Techniques
This is one of several procedures which involves creating many small holes in the bone underlying an area of cartilage degeneration. The subchondral marrow leeches through these holes initiating a repair response at the surface. The repair tissue is fibrocartilage, an adequate though mechanically inferior form of articular cartilage.
Cartilage Restoration Procedures
A group of procedures with the intention of patching the cartilage lesion. These include transplantation procedures, re-growing the patient’s native cartilage in tissue culture or replacing the damaged surface with donor (allograft) cartilage.
These procedures address issues related to the alignment or mechanics of the knee joint rather than directly repairing or replacing articular cartilage. They are often combined with open or arthroscopic articular cartilage procedures to correct issues related to stress placed on an area the joint, which may be causing cartilage deterioration. The underlying issue may be congenital, degenerative or post traumatic.
Interpositional Spacer Operations
The use of spacers to re-establish the narrowed or collapsed joint space of the knee. Though these procedures have potential benefit in the future, they are infrequently used due to limitations of current technology.
Joint Replacement Procedures
In the event of unrepairable cartilage surfaces, usually in the company of bone on bone, the partial or complete replacement of these joint surfaces may be indicated. Materials for joint replacement are the combination of metal and polyethylene plastic.
The meniscus may be resected, repaired or replaced (transplanted) depending on the several variables. The intention is to preserve the maximum amount of meniscal substance in attempts to maintain normal joint contact stresses.
The patellofemoral (kneecap) joint has its own unique kinematics and resultant cartilage wear patterns. A set of surgical procedures have evolved to address the special features of this joint.