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What is a Cartilage Lesion/Defect (Articular Surface)?

Articular cartilage lines each and every joint in the body and allows the joints to glide smoothly.  The surface is ultra-smooth and along with the normal lubricating fluid in our joints, the surfaces glide past each other with 20 times less friction than two pieces of ice! As the body undergoes wear and tear from everyday life or from injuries sustained in sports, the articular cartilage can become roughened or injured. Once an articular surface becomes roughened, the joint no longer glides smoothly. This is the beginning of arthritic wear and unfortunately often occurs with injury.

However, with new advances in medicine, it is possible to treat these rough areas. The procedures developed to treat these areas or lesions are referred to as cartilage preservation procedures. One procedure is a one-step technique where bone and cartilage plugs (pieces of cartilage) are removed from relatively non-weight bearing areas around the knee and plugged into the injured areas. This procedure is known as osteochondral autografting and is used to help stimulate bone and cartilage growth to repair roughened surfaces and to regain normal joint movement. The second and more recently described procedure is that of autologous cartilage implantation (ACI) or the Carticel procedure. This is done in two separate steps. First, chondrocytes (cartilage cells) are harvested from the knee via an arthroscopic procedure. Second, through an open procedure, the cells are re-implanted into the defect. Which procedure is appropriate is an individualized decision.

Causes

  • Fall onto knee
  • Sudden twisting injury

Signs & Symptoms

  • Dull aching pain especially after exercise
  • Occasional swelling
  • Clicking or popping
  • Locking of knee may be possible if loose body of cartilage is present

Treatment

As briefly discussed above, treatment for cartilage lesions is multifaceted. Normally a bout of conservative treatment is attempted, if the surgeon believes that the lesion may heal, with a period of rest and non-weight bearing. If the lesion will not benefit from conservative treatment, then surgical intervention is necessary to promote proper healing to the area of the lesion. Severity and location will dictate which and when a surgical procedure is utilized.

Osteochondral autografting is used to help stimulate bone and cartilage growth to repair roughened surfaces and to regain normal joint movement. It is done by taking pieces of bone and cartilage, known as “plugs” from a relatively non-weight bearing portion of the knee and using these plugs to fix the lesion or “hole” that is the source of pain.

Autologous cartilage implantation (ACI) is also used to help stimulate bone and cartilage growth. It is normally a two-step process. In the first step, cartilage cells are taken from the knee through a surgical procedure; these cells are then shipped off and “grown/multiplied” in a laboratory setting. Next, the harvested cartilage cells are re-implanted into the lesion or location of the cartilage defect. The new cartilage cells are normally implanted under a “patch” that helps mimic the native cartilage of the knee.

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