In this article, Dr. Sandeep Singh, Bhubaneswar’s excellent orthopedic surgeon, has discussed traditional and newly emerging knee cartilage replacement and restoration approaches.
Articular and meniscus cartilage are found in the knees. Articular cartilage aids in the free movement of the knee. Meniscus cartilage also acts as a shock absorber or cushion between the bones.
Both types of cartilage in the knee can be damaged by sports injuries, accidents, and years of normal wear and tear, necessitating repair or replacement. Osteoarthritis is a condition in which cartilage wears away.
Knee injuries can now be treated in a variety of ways thanks to advancements in orthopedic medicine.
In addition to Surgery, there are now minimally invasive treatments that use cartilage harvested from other parts of the body or cartilage grown from a person’s cells.
- Physical therapy
Physical therapy may be able to help you avoid surgery or other interventions.
The primary goal of physical therapy is to increase the strength and flexibility of the muscles that surround the knee joint to reduce the strain on the joint.
According to Dr. Sandeep Singh, the leading Orthopedic specialist from Bhubaneswar, physical therapy was found to help people with moderate pain, not just those with mild knee osteoarthritis.
Physical therapy has fewer benefits for people with severe arthritis pain, suggesting that the severity of pain should be considered when determining whether to seek physical therapy as a remedy option.
Weight loss accomplished by exercise and diet can usually help relieve knee arthritis signs in people who are overweight or obese, according to a separate study published in Seminars in Arthritis and Rheumatism.
Furthermore, according to Dr. Sandeep Singh from Bhubaneswar, losing one pound of weight relieves four pounds of joint stress in people with knee osteoarthritis.
So losing 5 pounds is the equivalent of removing 20 pounds of pressure from the knee joint.
Microfracture is one way to encourage the growth of new cartilage. Tiny holes are drilled in one or more bones in the knee joint to increase blood flow and release cells that form new cartilage in this procedure.
Microfracture is best for people under the age of 40, have had recent knee injuries and have small lesions or areas of cartilage degradation. Microfracture is not recommended for the treatment of large lesions or older adults with severe osteoarthritis.
After the procedure, you’ll need to keep your weight off your knee for about six weeks and bend and straighten it several times a day with a continuous passive motion (CPM) machine.
It could take up to 9 months to resume sports or other strenuous activities. Microfracture surgery also has the advantage of having a low risk of infection or other complications.
However, in some cases, the procedure fails to produce enough replacement cartilage, necessitating a different treatment in the long run.
- Cartilage resurfacing using cells
This procedure, also known as matrix-induced autologous chondrocyte implantation (MACI), is a two-step procedure for growing new cartilage.
An arthroscopic cartilage biopsy of the knee is the first step. After that, the biopsy tissue is sent to a lab, where the cartilage cells are manipulated to grow.
The surgeon shapes the new cartilage to fit the portion of natural cartilage that needs to be replaced when it’s ready to be implanted. Those who are most suitable for MACI are those who are young and have a high regenerative ability. Small isolated lesions less than the size of a dime have symptomatic cartilage injuries
According to Dr. Sandeep Singh, MACI is a safe and effective method of cartilage replacement for most people. Although MACI is typically performed as an outpatient procedure, you should expect to wear a knee brace for six weeks while your knee regains strength and stability.
Aside from the high cost and the need for two separate operations, another major disadvantage of MACI is the risk of cartilage overgrowth, which may necessitate the third surgery. The main arguments for MACI are that it is an effective treatment for small areas of cartilage repair and that it uses a person’s cells, which reduces the risk of the body rejecting it.
- Autograft of the osteochondral cartilage
This procedure, also known as a mosaicplasty, replaces worn-out cartilage with healthy cartilage elsewhere in the knee. An osteochondral allograft is a procedure that uses donor tissue to perform a similar procedure.
A surgeon removes the damaged cartilage as well as a portion of the underlying bone during the procedure. Consider the process of coring an apple. The hole is then filled with a replacement “core” made of bone and cartilage from another part of the body or a donor’s knee.
The replacement tissue is usually secured without the use of screws or mechanical devices. An osteochondral autograft or allograft, like other knee procedures, takes 4 to 6 weeks to recover before the knee can bear weight.
Within 6 to 9 months, with the help of rehabilitation, a complete return to sports or other activities should be possible.
Other disadvantages include the scarcity of donor tissue and the possibility of the body rejecting the implant. An allograft’s rehabilitation period is typically more extended than an autograft’s, but an autograft generally is less expensive and has a lower risk of complications.
According to Dr. Sandeep Singh, autografts provide satisfactory results for at least 10 years in 72% of people who have them. Young people are the best candidates for this procedure because more regenerative cells are available for the graft.
Furthermore, an allograft is commonly used to repair worn cartilage no larger than a dime in size. On the other hand, an autograft is a more invasive surgical procedure because it involves the removal of healthy tissue from elsewhere in the body. Some people are also hesitant to risk problems resulting from healthy cartilage and bone harvest, even if it is a small one.
- Knee replacement
Severe knee arthritis may necessitate a knee replacement if other less invasive approaches have failed to improve pain and mobility. An incision is made above the knee and down past the knee joint to begin the procedure.
The damaged knee joint is then removed in its entirety or part and replaced with a prosthetic knee joint that mimics the movement and function of a natural knee. Metal, plastic, and ceramic materials are used to resurface worn-out surfaces of the knee that were previously covered in cartilage to provide new gliding surfaces.
As a result, it’s critical to speak with your insurance provider about your costs and determine how much the procedure will be covered. Most people can resume normal activities within six weeks of surgery if they participate in physical therapy, though full recovery can take several months.
On the other hand, knee replacement can ultimately return complete function to the knee joint and reduce the pain that makes walking or even standing difficult. Robotic surgery is used to improve component positioning, biomechanics, and movement quality in knee replacement surgeries.
Knee replacement surgery, like any other surgery, carries the risk of infection and other complications. Because the knee is such a complicated joint, the prosthetic knee may fall short of your expectations.
As a result, you may need to consider a second surgery or learn to live with your new knee.
Knee cartilage replacement has several advantages.
When knee cartilage is severely injured or worn down to the point where it no longer gives smooth bone mobility in the joint or cushioning between the bones, it can cause daily pain and reduced mobility.
It’s not a situation that will get better on its own.
Knee cartilage repair or replacement can:
- Provide pain relief
- Delay or prevent osteoarthritis and other complications by improving knee function.
Consult a doctor to determine which procedure is best for you.
However, surgery isn’t always the best option. Some invasive intervention is likely for severe cartilage damage.
Your age and level of activity are two essential factors in determining which method is best for you.
Another factor is the nature and severity of your knee problem.
Make sure to ask your doctor about the procedures and recovery times that are involved.
Whatever knee cartilage treatment you choose, you should expect a lengthy recovery and rehabilitation period. According to Dr. Sandeep Singh, any cartilage resurfacing procedure requires rehabilitation to be successful.