CARTILAGE REPAIR AND TRANSPLANTATION
Injuries and degeneration of joint articular cartilage are common. Until recently, treatment options have centered on conservative treatment of medication, ice, therapy, rest, or cortisone shots. Surgical options have included arthroscopic abrasion or laser treatments or joint replacement. The most recent treatment plan is known as cartilage transplantation. The procedure is quite extensive and has many limitations; thus SportsMed wants the patient to understand the entire workings of this procedure.
The principle of this new procedure is quite simple. Normal cartilage cells are harvested during a smaller arthroscopic procedure when a single articular cartilage defect, usually in the knee, is identified by the surgeon. These cells are then sent to the Genzyme lab in Boston, Mass., where they grow for several weeks. Then, through a very large incision (not arthroscopic), the new cells are placed back into the defect and sealed by a layer of tissue from the leg bone (tibia). This second procedure may require hospitalization for one to two days. Weight bearing activities are restricted for a period before extensive rehabilitation begins. Athletic activities and strenuous work obligations are not permitted for six months to a year. Although this procedure has been done for years in Sweden, the experience in the United States is quite limited. However, the FDA has extensively reviewed this technique and does not regulate it or consider it experimental.
The majority of cartilage transplantation has been performed on the distal femur bone in the knee. There are many conditions which are unfavorable for this procedure including but not limited to arthritis, infection, malalignment problems, and obesity.
Cartilage repair is quite a new concept to most orthopedic surgeons and the company growing the cells and gathering the data in Boston does not allow physicians to use their services without specific on site training in the Massachusetts laboratory.
It is important to note that cartilage transplantation is best suited for patients between the ages of 14-48, who are not overweight, have relatively healthy and well-aligned joints with defects less than one centimeter. The post-operative course may be painful for several weeks and insurance companies may resist the procedure because of cost and lack of substantial data.