How Cartilage Restoration Eases Pain and Restores Knee Function
As a former ski instructor, triathlete and a member of the physician pool for the U.S. Ski Team, Dr. Aaron Black, an orthopedic surgeon at Summit Orthopedics, understands the key role healthy cartilage plays in helping his patients stay active. Which is why he’s so passionate about cartilage restoration, a set of innovative surgical procedures that resurface, realign and stabilize joints. Cartilage restoration, which is most often performed on the knee, can restore normal cartilage function.
Cartilage is the strong, flexible connective tissue that covers the bones where they come together to form a joint. Cartilage allows bones to glide over one another with less friction than ice on ice. It also acts as a cushion and helps support your weight when you run, bend and stretch. Cartilage can become damaged through injury or normal wear and tear, resulting in bone rubbing on bone. If left untreated, particularly if the cartilage is located in a large joint such as your knee, it may become difficult or even impossible to walk.
Dr. Black says cartilage restoration can be life changing, especially in his Summit County patients who tend to be active throughout their lives. It can push back the deterioration of the joint – and the need for a joint replacement – by as much as 10 to 20 years. An ideal candidate for a cartilage transplant is a relatively younger active individual experiencing chronic knee pain. The procedure is most effective when used for a contained cartilage injury with an otherwise intact joint. It is not used to repair widespread deterioration from age-related arthritis.
Your surgeon can determine whether or not you have damaged cartilage through an MRI (magnetic resonance imaging). There are two types of cartilage transplants: autograft and allograft. An autograft transplant involves moving both living cartilage and bone, called a graft, from one part of your body to another. The graft is most often taken from a non-weight-bearing part of your knee and consists of plugs of bone with overlying articular cartilage. Holes or sockets are made in the damaged cartilage and one or more plugs are shaved to fit the exact space before being pressed into place. Dr. Black describes the process as being highly precise, akin to artisanal carpentry. An autograft transplant is performed arthroscopically, meaning the surgeon makes several tiny incisions and uses a miniature, high-powered camera to view the surgical area and perform the procedure.
The second type of transplant, called an allograft, uses donor cartilage from a cadaver. An allograph is typically used when there isn’t enough healthy cartilage to harvest from the patient’s own body or if a larger graft is needed. The surgeon sends precise measurements of the damaged area to an organ bank, where they wait for an exact fit. Similar to an autograft transplant, the plug consists of both cartilage and bone. An allograph is typically performed with an open incision.
An autograft procedure takes approximately 45 minutes and an allograft procedure takes approximately one hour, depending on the size and complexity. Both procedures have a high success rate because, as Dr. Black describes it, joints exist in a “protected space” outside of the immune system. This means there is no risk of rejection nor need for special medications. The resurfacing of the joint is also completely biological, meaning there is no metal or plastic and you retain all of your native bone.
To enhance healing, Dr. Black soaks the allograft’s bony component in platelet rich plasma (PRP). This procedure involves extracting biologically active cells from the patient’s blood and injecting them back into the surgical area to stimulate repair cells. Because bone is alive, the transplanted bone will knit together with the patient’s surrounding bone. Dr. Black recommends his patients remain moderately active during the healing process because movement cycles nutrients to the surgical site and helps rid the area of waste products. Patients typically return to rigorous, high-impact activities within six to eight months.
Until now, it has been difficult to restore cartilage to normal function because it has such a poor blood supply. Cartilage transplant represents a major advancement in orthopedic medicine and it’s available here in Summit County. “I was drawn to orthopedics because it is an area of medicine that is reconstructive,” says Dr. Black. “I liked the idea of helping people get back to doing what they love.”