The Center for Joint Preservation and Replacement
offers a wide variety of salvage and joint restoring treatments for damaged
joint surfaces. These involve both arthroscopic methods as well as advanced
tissue transplantation for more extensive lesions.
What is Cartilage ?
There are several types of cartilage in your body .
Cartilage is found in the supporting structure of your nose,ears,ribs,and on
the surfaces of joints. A joint is a bending point where two bones meet . The
knee ,hip ,and shoulder are the three largest joints .
The specialized covering on the ends of bones that meet
(articulate) to form a joint is called hyaline or articular cartilage.It is
the cartilage that wears when we overdo,age,or sustain an injury . Articular
cartilage is unique in that it has no nerves or blood supply. This means
that
Damage will not be felt until the covering wears down
to bare underlying bone .Bone is very sensitive and the sharp pain of
arthritis often comes from irritation of bone nerve endings.
Most importantly,since human tissue cannot heal without
a blood supply ,articular cartilage cannot repair itself.
Terms Commonly Used That Describe Cartilage
Injury
Acute Damage: any disruption of a
joint surface from a sudden injury such as a fall,twist,or direct blow. The
resulting damage may leave a defect in the joint surface or a loose body�
that floats in joint.
Chronic degeneration : Wear and Tear
damage that is typical of arthritis. The surface becomes progressively
softer,thinner and eventually falls away exposing bare bone.
Chondromalacia
:(chondro=cartilage,malacia=softening) a degenerative subgroup of
cartilage wear and tear often seen under the kneecap (chondromalacia
patella)
Osteochondritis dissicans: a unique
focal damage thought to be associated with separation of underlying bone
.Commonly seen in children
Specialized Options Offered at the Center
:
Microfracture : This arthroscopic
technique can be performed as an outpatient procedure. The strategy is to
improve the blood supply to the bare areas of the joint by creating tiny
perforations in the underlying bone.The resulting bone marrow bleeding carries
powerful growth stimulating factors found in platelets as well as stem cells
to the damaged area.Healing and repair follow over several weeks. The
cartilage defect is filled with a fibrocartilage tissue that can return
function such as running and sports play. This method works best in isolated
defects up to 1cm in diameter. Fairly durable,it has been successful even in
NFL football players.
In addition,the Center is involved with research to
improve the outcome of this proceedure using growth stimulation with
Crystilin,a blood clotting factor.
Osteochondral articular transplantation
: For defects up to 3cm,osteochondral articular transplantation has
proven useful. Special instrumentation has been devised to harvest plugs of
articular cartlilage and its supporting bone from the patients own
joint,typically the knee.
The harvested tissue is then transported to the damage
site where it is inserted into prepared holes.Several plugs can fill up rather
larger defects and will grow to resupply a new joint surface.
Larger defects can be filled with a`single large
osteochondral plug taken from a cadaver (allograft) .
Autogenous articular cell implantation ( ACI ): When
defects exceed 3-4cms,joint surface restoration must rely on the
transplantation of cartilage cells collected from the patient ,grown to many
millions in cell culture,and then reimplanted into the joint. The orthopedic
staff at the Center has had special training to perform this procedure.
Other Solutions to Damaged Articular Cartilage
:
Arthroscopic chondroplasty:
Chondroplasty is a term referring to the arthroscopic smoothing of unstable
articular surfaces either with mechanical shaving or thermal devices. While
not a restorative measure,so called debridement can be useful in reducing
irritating cartilage debris that breaks off in the joint or causes catching or
grinding sensations.
The resulting improvement in the control of
inflammation can last for several years. While never a`final
solution,chondroplasty offers a conservative option to avoid more aggressive
surgery. Recently,clinical research has suggested an additional placebo effect
from such treatment as an added benefit.
Solutions to That May Relieve Pain But Have Not
Been Shown to Heal Articular Cartilage Damage:
Anti-inflammatory medication: Asperin
was the first anti-inflammatory medication in the world .This was followed in
1950 by cortisone ( steroidal medication) used orally or by injection.Later
the non-steroidal drugs such as Motrin came along.Thewse were safer than
Asperin and cortisone but had potent side effects especially bleeding stomach
and intestinal ulcers .These complications led to the development of the COX-2
inhibitor drugs,Celebrex and Vioxx. While mush safer and seemingly more
effective,Vioxx was found to have significant cardiac side effects andis no
longer available.With certain precautions,Celebrex is still widely used.
However, these medications only treatment the symptoms of cartilage damage and
arthritis and do not promote repair. Extensive use of cortisone not only has a
wide variety of harmful effects,but is laso believed to harm cartilage.
Alternative medicine: Dietary
supplements have gained some reputability in the treatment of arthritis. The
most well known and best studied of these so called nutriceuticals are
glucosamine and chondroitin sulfate. While significant rebuilding of damaged
cartilage has yet to be demonstated in humans,reports consistently documents
improvement in pain. For further information see our section on alternative
medicine.
Accupuncture: Despite many studies to
validate its use,accupunctre treatment for cartilage damage has not been
proven to heal joint surface defects. While pain relief has been reported,it
is usually short term . Accupuncture therapy is expensive and may delay more
effective treatment to save your joint. It may be useful as a last resort when
surgery is medically contraindicated;but that is rarely the case.
Other : There is an endless list of
products sold to health care consumers(patients) with the promise of pain
relief.Note that these products carely avoid false promises of truly healing
your problem. Copper bracelets,magnets, and various electrical devices are
popular with those patients who either don�t really need more or are receiving
bad advice about their care.Solutions that are expensive , require repeated
application, delay more effective care,and may have side effects should be
carefully avoided.
