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.
