Knee Cartilage Preservation in Surrey

What is Cartilage Preservation?

The knee joint has two types of cartilage within it; 

• Smooth articular, or hyaline, cartilage which lines the ends of the bones.
• Firm fibrous-type cartilage, known as menisci, which acts as a shock absorber between the bones.

As the smooth, articular cartilage wears away, the knee joint develops osteoarthritis, leading to pain, swelling and deformity. Eventually, if all the cartilage is worn away, a knee replacement may be required.

Cartilage preservation refers to a variety of procedures that can be used to reduce the loss of articular cartilage, or replace areas of damaged cartilage, to improve symptoms and avoid the need for knee replacement surgery. The type of cartilage preservation surgery you might require will depend on the location, pattern and severity of any damage.

This type of procedure may be performed in conjunction with others, such as ligament reconstruction, meniscal repair, and osteotomies, to improve the longevity of the cartilage preservation surgery.

Options available

Microfracture

This is a procedure whereby small potholes or defects within the articular cartilage can be filled in by encouraging the body to regrow new cartilage.

This is normally performed arthroscopically (minimally invasive). Tiny drill holes are placed into the bone at the base of the articular cartilage defect to encourage bleeding into the pothole.

As a result, a fibrocartilage cap forms over the underlying bone.

This is suitable for isolated smaller defects.

Osteochondral autografts or mosaicplasty:

In autograft or mosaicplasty, small cores of bone with a cartilage covering are taken from non-weight-bearing aspects of your knee. We then transport them into the area where the defect has been found.

The benefits of this are a solid, smooth, new surface is created for the weight-bearing part of the joint, reducing symptoms during physical activity.

This is better suited to larger defects within weight-bearing portions of the knee.

Osteochondral allografts or BioUni surgery

This involves matching a segment of articular cartilage and underlying bone from a cadaveric donor to the shape and size of the defect within your knee. We then transplant an appropriately extracted osteochondral graft in order to re-surface your joint.

This is more suitable for full-thickness defects or those unsuitable for grafts from your own body.

ACI/MACI

Autologous Chondrocyte Implantation is a procedure whereby cartilage cells are harvested from your knee and sent to a special laboratory.

There the cells are grown, in a medium or on a matrix, and then transplanted back into your knee to fill out the defect in the cartilage.

In certain circumstances, this has been shown to be effective, but is carried out only in a small number of specialist centres throughout the UK.

Please speak to your surgeon about whether this procedure is suitable for you.

Why would I need cartilage surgery?

Cartilage preservation surgery is useful for patients with isolated or small full-thickness articular cartilage defects.

The benefit of cartilage preservation surgery, over a partial or total knee replacement, is that it avoids having to lose good bone and cartilage stock that may be present.

What happens after surgery?

The procedure is normally carried out through either an arthroscopic or small open approach, depending on the type of defect and surgery.

It will either be done as a day case, or an overnight stay, and the post-operative rehabilitation depends on the type of surgery.

You may need to wear a brace, to restrict bearing weight or your range of movement, to protect the cartilage that has been restored. We work with several expert physiotherapy teams who will help you and make sure you recover following this sometimes complex surgery.

Recovery Milestones After Cartilage Preservation

Weeks 1 to 2: 

Over the first couple of weeks, it is important to rest the knee, get the swelling and bruising to subside, and gradually work on your range of movement within the parameters set by your surgeon. This will depend upon the type of surgery you have had.

Weeks 2 to 12:

Our physiotherapy services will guide you during this period, and the exact milestones we expect you to reach will vary, depending on the type of surgery you have had. This will be discussed with you by your surgeon.

Frequently asked questions

How long will I be in hospital?

The average length of stay is between 1 and 2 nights for the majority of cartilage preservation procedures.

When can I return to work?

This is highly dependent upon the type of surgery you have had. Please discuss this with your surgeon.

How will I know if cartilage transplantation or preservation is appropriate for me?

At your first consultation, your surgeon will examine your knee and carry out a number of investigations, normally including an MRI scan. This will generally give us a good idea of the pattern and severity of articular cartilage damage to your knee.

Occasionally an arthroscopy may be performed, to fully inspect the knee joint. Once we have gathered as much information as is necessary, your surgeon will know whether or not cartilage preservation surgery may benefit you, or whether to recommend treatment that does not involve surgery, or a knee replacement.