New Ways to Restore Joint Surface Damage
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 procedure 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 cartilage 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. These 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 and is 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 also 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 demonstrated in humans,reports consistently documents improvement in pain. For further information see our section on alternative medicine.
Acupuncture: Despite many studies to validate its use, acupuncture treatment for cartilage damage has not been proven to heal joint surface defects. While pain relief has been reported,it is usually short term. Acupuncture 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 carefully 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.