Articular cartilage is the substance that coats the bones inside the joint to allow smooth movement between the surfaces. When damaged or worn the bone ends are unprotected and this causes pain. Once this cartilage damage has occurred it does not re-grow. There are lots of techniques than have been described in surgical journals and in the national press to attempt to re-grow cartilage, transplant cartilage or to put similar biological materials in that gap. Many of these described techniques are experimental and have only very short follow-up data. Mr Bourke and Mr Kucheria spend a lot of time reviewing current scientific research from around the world and will only use surgical techniques that have tried and tested results.
This remains the ‘gold standard’ technique for small defects in healthy articular cartilage. The surgery is done arthroscopically (through keyholes) and is usually a day case procedure. It opens small passages in the bone through to the bone marrow to allow marrow cells to gather in the defect producing a scar tissue called fibrocartilage which fills the defect. Following this type of surgery you may be on crutches for up to six weeks to allow the area to heal before you begin normal activities.
Mr Bourke has recently started using a new technique for cartilage defects that cover larger areas or where microfracture has failed previously. This technique is known as BMAC (bone marrow aspirate concentrate) and involves taking stem cells from the hip bone through a very small incision (5mm). It is a one-stage procedure. These stem cells have the ability to transform in to cells that produce cartilage once inside the knee. Recent research form Milan, Italy has shown promising results at three years post-surgery with 80% of the defects having completely refilled with cartilage1.
1. Gobbi A, Karnatzikos G, Sankineani SR. One-step surgery with multipotent stem cells for the treatment of large full-thickness chondral defects of the knee. Am J Sports Med. 2014 Mar;42(3):648-57