| Treatment
of cartilage injuries Treatment of cartilage injuries depends on numerous factors such as symptoms, age of the patient, and the size, depth and location of the cartilage ulcer. Selecting the right treatment option is a complex process, best carried out in consultation with an orthopaedic surgeon. Some of the options are listed below:- Debridement Simple, small and shallow cartilage ulcer may only require debridement or "cleaning up" to smooth out the rough surface or any shallow unstable flaps of cartilage. This can be performed at the time of arthroscopy.  MicrofractureThis is also performed at the time of arthroscopy. Small holes are made in the base of the ulcer. This cases bleeding which allows for healing. The ulcer usually fills in with a type of cartilage called fibrocartilage, which is different from normal joint cartilage (hyaline cartilage). Success rates are generally still quite high, particularly for smaller ulcers. The picture on the right demonstrates microfracture of a cartilage ulcer, with bleeding from the small holes made in the base of the ulcer. Cartilage resurfacing Cartilage resurfacing involves attempting to replace the ulcer with cartilage that is the same as, or similar to normal joint cartilage (hyaline cartilage). One option is mosaicplasty, which uses small circular plugs of cartilage and bone taken either from the patient, or from cadaveric tissue. These plugs are then applied to the ulcer like mosaic tiles - hence the name, mosaicplasty.  Another option is using the patient's own cells,
either cartilage cells or bone marrow stem cells, to attempt to re-grow
new cartilage in the ulcer. This technique is called Autologous
Chondrocyte Implantation (ACI). Typically this requires 2
separate operations, the first to harvest the cells, and the second to
implant them. Culturing the cells usually takes between 3 to
6 weeks. The picture to the right shows ACI performed on a 3
cm square cartilage defect.The implantation surgery is usually open traditional surgery, in which the cells are applied to the ulcer, with a layer of tissue (periosteum) sutured over the ulcer to cover it and keep the cells in place. Another option is the use of artificial scaffolds which have the patient's cells embedded in them, and these scaffolds are then stuck to the base of the ulcer. Back to cartilage information page. Back to main patient information. |
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