David Menche M.D.
Repairing Articular Cartilage - Continued
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Repairing Articular Cartilage
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Osteochondral Allograft

For larger defects of both bone and cartilage loss, surgeons may custom fit an implant of freshly donated cartilage and bone. This transplant may allow restoration of the joint surface.


Future Techniques

rac_6Biologic tissue engineering is continuing to bring exciting new approaches from the lab to the clinical arena. It may be possible to use primitive cells from the bone marrow or periosteum (which have the potential to develop into several different types of cells, thus called pluripotential cells or in this case mesenchymal stem cells) and induce them to transform into hyaline cartilage. A variety of growth factors or local hormones may also come into play in creating the right “local environment” for hyaline cartilage to develop and remain healthy or even allow the hyaline cartilage to heal itself. Genetic reprogramming may in time replace surgery—but not at this point in the new millennium.

Other biopatches may have the predominant purpose of acting as a temporary home for chondrocytes or “pre-chondrocytes”. They may be used to deliver and maintain the cells in proper position until the healing response takes effect. This exciting field will offer many new surprises which will hopefully lead to opportunities for restoring function in less and less invasive means.


Established Arthritis

Many patients suffer for years with arthritis that limits even the simplest activities.  Fortunately, joint reconstruction surgeons have a wide range of methods to relieve pain and help restore function.


Injectable Viscosupplementation:

Surgeons inject the knee with a substance that may offer relief by possibly improving both joint lubrication in the short term and the biochemical enviroment in the intermediate term. The injectable options will continue to evolve.

Intra-articular (into the joint) injections of a natural lubricant (not cortisone) are now available as an FDA-approved procedure for the treatment of osteoarthritis.  Results are variable and dependent on the degree of osteoarthritis present. When symptomatic improvement occurs, significant relief of symptoms can last for six months or longer..


Osteotomy:

When the bones do not align properly, joint forces are not evenly distributed and may overload one side causing pain and possibly degeneration. With an osteotomy (means cut in the bone), the surgeon cuts the femur or tibia and then realigns the bones.

After healing, the bones are in a new position and force (weight) is shifted from the overloaded or damaged side to the more normal or underloaded side of the joint

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Unicompartmental Joint Replacement:

This procedure replaces only the damaged portion of the joint with metal and/or plastic, leaving the remainder of the joint intact.


Total Joint Replacement:

If there is extensive damage which precludes the use of the above procedures, then all of the knee joint surface is replaced with artificial components allowing most patients to return to limited pain-free activities.