Scott & White Healthcare – Round Rock is performing several types of knee “articular” cartilage procedures in patients who suffer from a traumatic injury, congenital defect, or certain kinds of osteoarthritis. The procedures, done either arthroscopically or as open surgery, range from stimulating the body to repair the damaged tissue on its own to those that involve transplanting bone and cartilage from cadavers to replace the defective tissue. Candidates for cartilage transplantation include patients with a small, localized area of cartilage damage.
“With cartilage transplantation, our goal is to bring normal tissue back to the injured area to try to restore the weight-bearing cartilage surface as best as possible,” said Darryl B. Thomas, M.D, sports medicine fellowship-trained orthopedic surgeon at Scott & White – Round Rock and a leader in the field of cartilage transplantation. “These procedures may offer active patients a way to get back to an athletic lifestyle with relatively pain-free range of motion.”
Cartilage transplantation uses grafts of cartilage and bone that are taken from the patient’s own tissue or from a donor cadaver. The grafts are harvested from a non-weight bearing part of the donor knee which has a supply of healthy “articular” cartilage. They are then transplanted into the patient’s knee at the site of “articular” damage. Patients who’ve not had success with a chondroplasty – “cleaning up the cartilage” or a microfracture – “stimulation of the bone marrow to grow new cartilage-like cells” may benefit from cartilage transplantation.
“I tell patients up front that this isn’t for everyone — they must be willing to go through prolonged rehabilitation,” said Dr. Thomas. “This is not your standard arthroscopy procedure with just a few days on crutches and then you’re back to normal activity. Oftentimes these procedures can’t be done arthroscopically, and require larger incisions to gain better exposure of the damaged area. As a result, these surgeries often have a longer recovery period before returning to activity.”
Dr. Thomas sees patients of all ages for cartilage transplantation anywhere from teens to 60-year-olds. “Once you reach your 60s, you generally don’t have localized arthritis and you’re not usually a good candidate for cartilage transplantation. More often than not, these patients will be looking at partial or full knee replacement surgery if traditional non-operative methods of treatment have been unsuccessful.”
According to Dr. Thomas, as more and more people have gotten into sports, not just at the recreational level, but collegiate level, there’s been a steady increase in focal cartilage injuries. Dr. Thomas expects to see a spike in cartilage injuries as many people enter personal fitness programs and as more baby boomers continue to be physically active later in life.
“To allow patients to continue to be physically active as long as possible, I try to do everything I can to repair, restore, or resurface the knee’s cartilage surface and prevent them from needing a total knee replacement early in life. This is especially true when the patient had a cartilage injury or other sports-related injury at a young age. It’s better in the long run to restore or repair your own knee cartilage if at all possible.
In many cases, patients don’t even know about cartilage transplantation as an option. They’ve been told that because of their knee arthritis they either need to give up certain activities they love, or wait until they’re painful enough to need a knee replacement.”
“Articular” cartilage transplant patients are typically referred by a primary care doctor or another orthopedic surgeon. “If a patient’s orthopedic surgeon doesn’t perform or offer some of these cartilage restoration procedures, they should not feel uncomfortable asking for a second opinion from a surgeon that does,” said Dr. Thomas.
As with any surgical procedure, there is a small risk of infection. Additionally, because donor cartilage may be used, there is some minor risk of disease transmission. “Graft rejection, however, is not usually a problem,” said Dr. Thomas. “Although these procedures can require a prolonged post-operative rehabilitation period, they offer patients a chance to return to a relatively normal lifestyle, when no other good surgical options are available.”