Cartilage Transplants: Innovative Knee Treatment For Younger, Active Patients

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Cartilage transplants are a new, effective way to treat painful, localized articular cartilage damage in a joint – primarily the knee – for active patients, from their teens to 50s.

These innovative procedures – called matrix-induced autologous chondrocyte implantation (MACI) – are completed in two stages, says Eric Fester, MD. Dr. Fester is the first Dayton physician to perform MACIs. 

Healthy articular cartilage – the smooth, white tissue that covers the ends of bones where they form joints – enables your joints to move smoothly, without pain.

But cartilage damaged by wear and tear or injury makes joint movement difficult and painful, requiring medical or surgical intervention, such as MACI transplants.

In MACI transplants, the transplant recipient is also the donor (that’s what “autologous” means). 

In the first stage of an MACI procedure, Dr. Fester explains, he removes a tiny piece of healthy cartilage tissue from a non-weight-bearing area of the patient’s knee joint, through a small arthroscopic incision. 

In a lab, this tissue grows, on a membrane, into a larger piece of cartilage. In the second stage of the MACI procedure, Dr. Fester transplants the cartilage-bearing membrane into the damaged area of the patient’s cartilage through an open incision. 

The recently advanced version of the MACI procedure performed by Dr. Fester shortens the length of the second part of the procedure from two and half hours to 45 minutes. This improves results and reduces recovery time and potential complications such as infection and blood clots. 

“MACI provides a nice uniform fill of the damaged area with a high density of healthy cartilage cells, so it grows in well to repair the damage,” Dr. Fester explains.

Other Cartilage Restoration Options

MACI cartilage transplants are the newest of several surgical options for repairing localized cartilage damage. These procedures reduce the risk of further cartilage deterioration, which may lead to osteoarthritis and eventually require total joint replacement surgery.

Dr. Fester says that if you’ve been diagnosed with damaged cartilage, Premier Orthopedics helps you create a treatment plan that best fits your needs, based on: 

  • Size and location of your cartilage damage
  • Your age
  • Your activity level
  • Preexisting conditions, such as ligament injury or arthritis in the knee

Your treatment plan may include:

  • Physical therapy
  • Athletic training
  • Platelet rich plasma (PRP), or stem cell, injections.  This involves drawing your blood, spinning it in a centrifuge to obtain the plasma, and injecting it into your injured joint to help heal the injury.
  • A surgical option

Besides MACI, other surgical options for cartilage restoration include:

  • DeNovo technique, a transplant procedure that uses donor cartilage, instead of your own cartilage
  • Microfracture, in which tiny holes are drilled in the bone, at the base of the cartilage damage. This allows bone marrow cells, or stem cells, to bleed through to form a clot that turns into new cartilage.
  • Abrasion arthroplasty, in which the surgeon uses a high-speed burr to remove damaged cartilage, causing the bone to bleed, bringing the same results as microfracture: formation of a clot. “In a matter of a few months, the clot becomes cartilage,” Dr. Fester says.
  • Realignment surgery, or osteotomy, in which a surgeon removes, or sometimes adds, a wedge of bone near a damaged joint to shift weight from the area of damaged cartilage 
  • Meniscus transplant, to replace torn cartilage that stabilizes and cushions the knee joint

Risks Of Cartilage Restoration

“The biggest risk of cartilage restoration is that it doesn’t work – that the implantation doesn’t ‘take’ or heal and then the lesion gets larger and the patient develops an arthritic joint (requiring joint replacement),” Dr. Fester says.

Other risks include infection, blood clots, and joint stiffness.

“The larger the lesion, the older the patient, the higher chance the procedure won’t work.” Dr. Fester says, “I have a heart-to-heart with the patient and go over the benefits, the risks, what are the chances that it will work, what are the chances it won’t.”

When considering cartilage restoration, Dr. Fester advises patients to look for an orthopedic surgeon who is fellowship-trained or specially trained in sports medicine and experienced in the full range of cartilage restoration procedures. 

“It’s not cookie cutter. It’s a matter of picking the right procedure for the right patient so they get the right outcome.”



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