James S. Kercher, MD - Orthopaedic Surgeon
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Cartilage Restoration
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Cartilage Restoration

Articular cartilage is a complex avascular (no blood supply) tissue which consists of cells called chondrocytes suspended in a collagenous matrix. It appears as a smooth, shiny, white tissue at the ends of the bones which come in contact with each other to form a joint. It reduces the friction when the bones glide over each other and makes the movements smooth and enables the joint withstand weight. Alternately, it acts as a shock-absorber.

This cartilage is subjected to the normal wear and tear and may sometimes get damaged because of injury causing pain and impaired function. There are several surgical methods that have been devised to restore the articular cartilage as it does not heal by itself and may even progress to arthritis.

Most of the cartilage restoration procedures are done using an arthroscope. During the procedure, three small puncture incisions are made around your joint. In some procedures, longer incisions may be required to gain access to the affected area. Overall, your recovery after arthroscopic procedure will be faster and less traumatic than open surgery.

The surgical procedures performed for cartilage repair or regrowth include:

Autologous chondrocyte implantation (ACI): It is a two step procedure, where healthy cartilage cells are removed from the non-weight bearing joint, grown in the laboratory and then implanted in the cartilage defect during the second procedure. During this procedure a patch is harvested from the periosteum, a layer of thick tissue that covers the bone and is sewn over the defected area using fibrin glue. The new cartilage cells are then injected under the periosteum into the cartilage defect to allow the growth of new cartilage cells.

Osteochondral Allograft Transplantation: In this procedure healthy cartilage tissue or a graft is taken from a donor from the bone bank and transplanted to the area of cartilage defect.

DeNovo: DeNovo® grafts are tissue grafts used in cartilage repair. These grafts consist of cartilage tissue collected from donors or grown in the laboratory using human donated cartilage cells. DeNovo® grafts are of two forms — DeNovo® ET (Engineered tissue) and DeNovo® NT (natural tissue) grafts.

DeNovo® NT graft contains particulated natural articular cartilage living cells harvested from juvenile donors (aged below 13 years). Transplantation of DeNovo® NT is a simple single-step procedure where the graft is fixed on the defect area using fibrin glue and no periosteal flap is required.

DeNovo® ET is an engineered tissue graft cultured in the laboratory using the cells collected from juvenile donors. The cells collected are cultured in the laboratory using cell-based technology. Juvenile cartilage cells have greater potential of regeneration than the adult cartilage cells. The graft can be placed over the defect area using single-step simple surgical procedure.

Osteochondral Autograft or Mosaicplasty: This grafting technique is indicated in patients whose articular cartilage damage is less than 2 cm in diameter. In this procedure, the hyaline cartilage is harvested from a non weight-bearing joint of the same individual (autograft) and transplanted in a mosaic pattern to the damaged area. The cells in the articular cartilage grow in the damaged area to promote healing. This procedure can be carried out arthroscopically or through open surgery.

Microfracture: This technique stimulates the formation of new articular cartilage by creating blood supply to the joint surface. The procedure is done arthroscopically. Multiple holes are made into the bone (subchondral bone) below the cartilage with a sharp tool called awl. This helps blood supply to reach the damaged cartilage and form new cartilage. Young patients with single lesion and healthy bone are suitable candidates for this procedure.

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