Cartilage Restoration

How cartilage restoration works

Two kinds of cartilage matter inside a joint such as the knee. Articular cartilage is the smooth, glassy layer covering the ends of the bones, allowing them to glide with very little friction. The meniscus is a separate wedge shaped structure that helps distribute load. Neither has the rich blood supply most tissues rely on for repair, which is why cartilage damage does not reliably heal the way a broken bone does.

Damage takes different forms: fissuring, where the layer splits; thinning, where the surface loses depth; flaps, where a portion has lifted from the bone beneath; and defects, where cartilage is missing and the underlying bone is exposed. The important distinction for restoration is between a focal defect, a discrete area of damage in an otherwise healthy joint, and widespread wear across the whole joint surface, which is what is meant by arthritis. Restoration procedures are generally aimed at the first situation.

Symptoms that often bring people in

• Pain localized to one area of a joint, often worse with weight bearing, squatting or stairs
• Swelling that comes and goes, particularly after activity
• Catching, clicking or a sensation of something moving inside the joint
• Locking, where the joint will not fully straighten or bend
• Persistent symptoms after a knee injury that seemed to settle at first

How cartilage damage is evaluated

Evaluation aims to establish where the damage is, how large and deep it is, and whether the rest of the joint is healthy, since those factors shape which options are realistic. Examination looks at the site of tenderness, swelling, range of motion and limb alignment. X-rays assess the joint space and alignment on standing views, since a bowed limb loads one side more heavily. MRI is most often used to see cartilage and the meniscus, and in some cases the full extent of a defect is only defined at arthroscopy.

Treatment options in general terms

Not all cartilage damage requires a restoration procedure, and non-surgical care is often the starting point.

• Activity modification. Adjusting loading and impact may reduce symptoms while the joint is assessed.
• Physical therapy. Building strength around the joint and improving mechanics can change how load passes through the damaged area.
• Bracing and injections. Braces that offload one side of the joint may be considered, and options including platelet rich plasma may be discussed.

Surgical options fall into several categories, and which are suitable depends on the size and location of the defect, limb alignment, and your age and goals.

• Arthroscopic debridement. Loose or unstable flaps may be trimmed so the surface is smooth and catching is addressed.
• Marrow stimulation. Small openings are made in the bone beneath a defect so cells from the marrow reach the surface and form repair tissue.
• Osteochondral transfer. A plug of bone with its cartilage cap is transferred into the defect, from a less loaded area of the same joint or from donor tissue.
• Cell based grafting. Cartilage cells are grown or prepared and implanted into the defect in a staged procedure.
• Meniscus repair or replacement. Preserving the meniscus protects the cartilage surface where tissue has been torn or lost.
• Realignment osteotomy. Where alignment is overloading the damaged part of the joint, the bone may be repositioned to shift load away from it.

What to expect when you consult Dr. Wolfson

Dr. Wolfson performs joint preservation and arthroscopic surgery and treats cartilage injuries in athletes and non-athletes alike. A consultation typically covers what your imaging shows about the damage, whether the surrounding joint is healthy enough for a restoration approach to make sense, and what rehabilitation each option would require. Related pages describe cartilage damage and muscle, tendon and ligament care.

This page provides general information about cartilage restoration and is not medical advice. It is not a substitute for examination, imaging and diagnosis by a qualified physician. Every case is different and requires individual evaluation. If you have severe pain, an obvious deformity, loss of function, fever, or an injury from a significant accident, seek medical care promptly.

Contact Dr. Wolfson if you would like to setup an appointment. If you are a new patient, please book all in-person appointments with Dr. Wolfson via telephone.

If you live outside of the San Francisco Bay Area, you can request a complimentary phone consultation with Dr. Wolfson to assess your case. Please call or e-mail us to set up your complimentary consultation.

Call: (415) 221-4400

E-mail: [email protected]