It’s no secret that the state of our roads here in Metro Detroit leaves much to be desired. Potholes seem to multiply overnight, wreaking havoc on our wheels and rims. While we commend the tireless road crews who work diligently to patch these road craters, it’s high time we consider more sustainable, long-term solutions for our transportation infrastructure. But today, we’re not just here to talk about potholes on our roads; we’re diving into the world of potholes that can develop within our own knees.
As an orthopedic surgeon and cartilage specialist, I draw inspiration from our road crews’ efforts and apply similar concepts to addressing knee cartilage damage. Just as road potholes can be a persistent issue, knee cartilage injuries can be equally perplexing. However, rest assured that we’re making impressive strides in finding solutions to fill these metaphorical potholes in your knees.
Before we delve into the innovative techniques available for cartilage restoration, let’s brush up on some cartilage basics. Articular cartilage, a robust tissue found within our joints, provides cushioning and enables smooth joint movement. Unfortunately, when articular cartilage is damaged, it doesn’t heal naturally. Hence, we rely on innovative approaches to either replace or stimulate the growth of cartilage. In the past, a significant cartilage injury often spelled the development of arthritis in young individuals. Thankfully, with recent advancements, we can now prevent arthritis from setting in by restoring injured cartilage.
It’s crucial to note that cartilage restoration surgery isn’t suitable for everyone. I often tell my patients to think of knee cartilage as pavement on a road. If the pavement is entirely worn out, similar to wear-and-tear arthritis, you might require knee replacement, partial knee replacement, or realignment through a procedure called an osteotomy. However, if the pavement is still good but has a “pothole,” we can potentially use cartilage restoration procedures to fill that pothole. These “pothole-filling” techniques generally apply to a younger patient population, although age isn’t the sole determining factor.
If you have a cartilage defect, injury, or “pothole” in your knee that hasn’t yet progressed to arthritis, here are some contemporary techniques we’re using for cartilage restoration:
This involves creating small holes in the bone where cartilage has worn away. Bone marrow cells migrate into the area, transforming into a protective layer of scar cartilage. Some newer procedures incorporate a layer of fertilizer to encourage the growth of better-quality cartilage.
In this procedure, a plug of bone and healthy cartilage is harvested from one area of the knee and transplanted to the injury site. For larger defects, we can even use plugs from cadavers. An even newer approach involves using cartilage cells from a “young donor” suspended in a gelatinous mold to fill the cartilage defect.
Healthy cartilage cells are extracted from the knee and cultivated in a lab. They are then incubated on an advanced biological membrane, ready to be reimplanted into the pothole. This represents the third generation of advanced cartilage restoration, with a more minimally invasive reimplantation process.
The Future of Cartilage Restoration:
Our ongoing research explores cutting-edge techniques that simplify the process of cartilage restoration, such as one-step procedures that mince cartilage cells, impregnate them on a scaffold, and staple the construct into a defect.
Other New Horizons:
We’re also investigating methods like gene modulation, growth factors, and upregulating receptors to attract stem cells to areas of the knee in need of repair. Exciting developments are on the horizon.
Stem Cell Therapy and Platelet Rich Plasma:
Both therapies play vital roles in the grand scope of articular cartilage restoration and arthritis management, and we’re continually refining these treatments.
How to identify a Cartilage Defect
You might wonder how to identify a cartilage defect in your knee. While many issues are diagnosed during arthroscopic surgery, our imaging techniques, especially MRI, are rapidly advancing and enabling us to detect cartilage problems more accurately. Recent research even used ultra-sensitive MRI technology to compare the knees of high-impact athletes like basketball players to low-impact athletes like swimmers. Despite asymptomatic knees, basketball players exhibited significantly more early cartilage damage. This discovery prompts us to reconsider how we train young impact athletes and emphasizes the benefits of low-impact exercise for all of us.
Another intriguing study involves using advanced MRI technology combined with bloodwork to screen for individuals predisposed to osteoarthritis later in life. The results are promising and may help us identify at-risk individuals earlier.
Ultimately, prevention remains the best treatment. While we can’t control our genetics, we have control over our lifestyle choices. Maintaining a healthy lifestyle is essential for cartilage health. A “cartilage-friendly” workout routine includes low-impact aerobic activities like walking, cycling, swimming, and cross-country skiing. Maintaining a healthy weight significantly reduces the strain on your knees and other joints. Additionally, consider supplements containing glucosamine and chondroitin for overall cartilage health.
If you’ve been diagnosed with a cartilage defect in your knee, it’s wise to explore options for addressing it before your “whole road goes to pot.” The world of cartilage restoration is advancing rapidly, and many of these groundbreaking procedures and research are being conducted right in our vicinity.
For more information on sports injuries and prevention, visit our website at https://www.unasourcesurgery.com/
Dr. Joseph Guettler is an orthopedic surgeon who specializes in sports medicine, as well as surgery of the knee, shoulder, and elbow. His office is located in Bingham Farms, MI. Visit https://miorthosurgeons.com/ for more information on Dr. Guettler and his practice, Michigan Orthopaedic Surgeons.