If you are in your 20's, 30's, or 40s and have a knee cartilage defect the pain can be debilitating on a daily basis. The injury that resulted in the pain may have been a car accident, sports injury, really anything that could've led to a cartilage defect in your knee that is now causing pain.
Just let's say that you are a competitive basketball player. You play at a very high level, and in one particular game you twist your knee and tear your ACL. You fall over after the incident and while you are falling, you end up with a medial meniscal tear and a cartilage defect. What would be the end result of all of the injury?
Well for starters in this day and age ACL reconstruction technologically has gotten very sophisticated and effective. So you could end up with an extremely functional ACL reconstruction from your own tissue or harvested from a cadaver. Also, if the medial meniscal tear is not extremely large it can be shaved down and the pain would no longer be there while enough meniscus would remain for appropriate shock absorption. The result though would be that you have a good amount of pain deep in the knee from the cartilage defect which could shorten your career and lead to a life of chronic pain.
The first treatment that works fairly well for a cartilage defect is called a microfracture treatment. It is performed as an outpatient arthroscopic knee surgery where the area of the cartilage defect is drilled multiple times through the bone slightly to generate some bleeding. With the bleeding present, there's able to then be some more cartilage production from the healing process being started. The cartilage that is produced unfortunately is not Type one native cartilage. It is call fibrocartilage and is not a great permanent fix for the defect. It will function well for a period of time, but the cartilage produces is not what you were born with.
The next treatment that works pretty well for a cartilage defect is called articular chondrocyte implantation (ACI). ACI is a procedure that involves harvesting some of your native cartilage cells and sending them to a laboratory for culture. After a few weeks when a sufficient amount of cartilage cells have been cultures they are then sent to the surgeon for implantation in the defect and overlying that a patch is placed to keep them situated while they grow in properly. This procedure works well but the problem is it involves downtime for the patient and another surgery.
The third procedure that works really well for a cartilage defect is called an OATS procedure which is an Osteochondral Autograft Transfer Surgery. Essentially what this involves is taking cartilage away from the part of the knee that is not a weight-bearing area and shifting over to the area where the defect is that is painful. It is done in multiple punctures that are circular and then essentially placed in mosaic type pattern in the hope that they will grow together with subsequent pain relief.
These three procedures are all performed as an outpatient knee arthroscopy and may work well for alleviating pain from a cartilage defect.
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