Osteochondral Allograft, Microfracture, OATS, and ACI Surgery of the Knee: Cartilage Restoration
Posted on June 10, 2009
Filed Under Sports Medicine | Leave a Comment
The best treatment for a knee injury or disease Is one of biologic origins that restores the knee to a state near normal. ACL (anterior cruciate ligament) reconstruction, anatomic repair of knee fractures, and meniscal repair are three types of biological surgical repairs that are very successful for injured knees.
A symptomatic full-thickness chondral lesion of the knee presents a problematic management issue for patients and orthopedists.
Injury leading to articular cartilage cell death can best be treated by restoring the surface cells of the joint. The surface cells are the articular cartilage. This is the shiny white surface of which all joints in the body are made.
There are 4 ways to treat damage to this tissue. They are: Autologous Chondrocyte Implantation (ACI), Osteochondral Allograft, Osteoarticular transfer system (OATS), and Microfracture.
Click here for more on Arthroscopy of the Knee.
In a young patient, a small lesion can be treated with Microfracture surgery. In this method, a pick-like tool is used to enter the marrow of the knee under the chondral defect. Multiple entries stimulate the bone marrow, which, in turn creates repair tissue. This tissue fills the chondral defect with fibrous cartilage tissue.
The patient will use crutches for about 6 to 8 weeks. He or she must forgo sports for half a year to a year. It may take as much as 18 months for complete relief of pain to be achieved.
It is possible to restore the knee surface to a near-normal condition with a procedure called autologous chondrocyte implantation (ACI). This procedure is used if the knee defect is large.
Articular cartilage cells harvested from the healthy part of the injured knee are used in ACI. This surgery may be used under very specific conditions.
Here are the surgical indications for ACI. First, the injury must be a full-thickness, symptomatic, weight-bearing chondral injury of the femoral articular surface. Second, the patient must be physiologically young. Third, the patient must agree to cooperate with the rehabilitation process for eighteen months.
ACI surgery on the patella and tibia is not always successful. Additionally, insurance companies often refuse to pay for this procedure. ACI is not considered a viable treatment for osteoarthritis. This is a condition in which two reciprocal joint surfaces have been damaged and x-rays reveal a narrowing of the joint space along with the formation of bone spurs. Knees may be assessed for ACI using a 3T MRI (magnetic resonance imaging). In this way, it can be determined whether or not ACI is the correct treatment.
Click here for more on Dr. Stefan Tarlow, a leading Phoenix knee surgeon.
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