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Sunday, July 5, 2009

Osteochondral Allograft, Microfracture, OATS, and ACI Surgery of the Knee: Cartilage Restoration

By Dr. Stefan Tarlow

Biologic treatments are best for knee disease or injury. Biologic treatment restores the knee to a near-normal state. Meniscal repair, reconstruction of the ACL (anterior cruciate ligament), and anatomic knee fracture repair are 3 of the types of biological surgical repairs that work well for knee injuries.

A symptomatic full-thickness chondral lesion of the knee presents a problematic management issue for patients and orthopedists.

Injury that leads to articular cartilage cell death is well treated by restoration of the surface cells of the joint. The shiny white surface that composes all the joints in the body is the articular cartilage or surface cell layer of the joint.

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.

In this scenario, the patient will be on crutches for a month to eight weeks. The patient must not participate in sports for a six months to year. Additionally, the patient must realize that it may take up to eighteen months to be completely pain free.

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.

ACI uses articular cartilage cells that have been harvested from the healthy part of the injured knee. There are strict indications and use criteria in place where cartilage restoration procedures are concerned.

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.

Surgery to the tibia and patella may not be successful. For this reason, insurance companies often refuse payment for surgery of this type. ACI is not a workable procedure for treating osteoarthritis. This is a condition in which two reciprocal joint surfaces are damaged. X-rays show narrowing of the joint space, as well as bone spurs. The use of a 3T MRI (magnetic resonance imaging) can assess for ACI. This procedure can help determine the proper treatment.

Click here for more on Dr. Stefan Tarlow, a leading Arizona knee surgeon. - 17273

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