Cartilage Repair and Transplantation

Cartilage restoration is a surgical procedure that aims to stimulate the growth of new cartilage to restore normal joint function and prevent or delay the onset of arthritis. Various techniques are used for cartilage restoration, including dietary supplements, microfracture, drilling, abrasion arthroplasty, osteochondral autograft, and allograft transplantation.

Dietary supplements, such as glucosamine and chondroitin, are non-surgical options for cartilage restoration. These substances are naturally found in the body and can prevent cartilage degradation and promote the formation of new cartilage. Other nutritional supplements, such as calcium with magnesium and vitamin D, S-Adenosyl-Methionine, and Methylsulfonylmethane, are also recommended.

Microfracture involves creating tiny holes in the injured joint surface with a sharp tool to stimulate a healing response and the growth of new cartilage. Drilling creates similar holes but is less precise and can produce heat that damages surrounding tissue. Abrasion arthroplasty uses a high-speed metal object to remove the damaged cartilage.

Osteochondral autograft transplantation involves taking healthy cartilage tissue from a weight-bearing bone and transferring it to the injured joint. This method is best suited for smaller cartilage defects. Osteochondral allograft transplantation uses a graft from a donor to transplant healthy cartilage tissue to the damaged area and is preferred for larger defects. Autologous chondrocyte implantation involves removing healthy cartilage from another part of the body, growing it in a laboratory, and then implanting it in the damaged area through open surgery.

Osteoarticular transfer system (OATS): Osteoarticular transfer system (OATS) is a surgical procedure to treat isolated cartilage defects which are usually 10 to 20mm in size. The procedure involves the transfer of cartilage plugs taken from the non-weight bearing areas of the joint and transferred into the damaged areas of the joint.

Performing this procedure is not recommended for widespread cartilage damage often associated with osteoarthritis.

The surgical procedure typically employs arthroscopy, where one or two larger plugs are harvested to fill the damaged area. First, the damaged cartilage area is prepared using a coring tool that creates a round hole in the affected bone. The hole is then drilled to a size that accommodates the plug, which is taken from a non-weight-bearing area of the knee and implanted into the damaged area. The size of the plug should be slightly larger than the hole to ensure a proper fit, allowing the newly implanted bone and cartilage to grow in the damaged area.

Complications of OATS may include donor site morbidity causing pain, avascular necrosis, and fracture. Other complications such as hemarthrosis, effusion, and pain may also arise. After OATS, rehabilitation is advised, including the use of crutches and limiting the range of motion