Knee Cartilage Regeneration

Knee articular cartilage is a tough elastic material that covers the ends of bones in a mobile joint. Joint cartilage allows the ends of the bones to effortlessly glide over one another, and to provide shock absorption. Wear of the articular cartilage is known as arthritis.

Dr Agolley is a knee surgeon on the Gold Coast that performs knee cartilage regeneration procedures for isolated areas of articular cartilage wear. The procedure helps to preserve the knee in the hope of avoiding early joint replacement.

What are the symptoms?

Cartilage wear in the knee may present as pain in the knee while bearing weight, with or without symptoms of catching, clicking or locking.

What investigations will be required?

Plain x-rays are essential to assess the presence of any bone injury, and to assess the alignment of the lower limbs. MRI is always helpful to help assess the size and grade of the cartilage lesion, and to identify any other injury.

When Should I have Surgery?

After non-surgical treatments are exhausted, the options to proceed with knee cartilage regeneration procedures will be discussed with Dr Agolley. When your knee pain is such that it is interfering with your enjoyment of life, it may be time to consider a procedure that would be tailored to you.

The surgical options available for cartilage regeneration include:

Microfracture: small holes are punched through the surface of the bone to encourage stem cells with blood clot to form in the cartilage defect of your knee, and encourage new fibrocartilage formation.
Autologous Chondrocyte Implantation (ACI): A biopsy is taken of your own cartilage and multiplied in a lab. The lab returns these cells in the form of an impregnated mesh, or in a solution, and this is transplanted to your knee cartilage defect.
Osteochondral Autologous Transplantation (OATs): Core’s of your own joint cartilage and bone is taken from a part of your knee that does not articulate with another bone, and is transplanted in to the weight bearing cartilage defect.
Osteochondral Allograft Transplantation: Core’s of donated cadaver joint cartilage and bone is harvested and transplanted to the weight bearing cartilage defect.
There are new synthetic transplantation options that are showing some promise in clinical trials

The most appropriate procedure for you will be discussed at your appointment with Dr Agolley.

The procedure and post-operative recovery

The specific type of procedures required during your knee cartilage regeneration procedure will be discussed with you prior to the procedure. In general for most patients:

Your anaesthetist will perform general anaesthetic
2 small keyhole incisions are made over your knee
The knee joint is examined and the specific procedures required are undertaken
The knee is irrigated and local anaesthetic is infiltrated around the knee
The surgical site is thoroughly cleaned and closed

The post-operative recovery consists of:

The majority of patients that have an arthroscopy and cartilage regeneration are discharged on the same operative day
Most patients are able to mobilise with crutches but not permitted to take any weight on the operated knee for 6-8 weeks. This gives the cartilage time to regenerate and any graft time to heal and incorporate in to your own bone.
Return to sedentary work 2-4 weeks
Return to heavy labour 3 months
Return to sport 4-6 months

Specific precautions

There may be numbness around your surgical site. This usually resolves quickly, but may persist for several weeks. Major nerve or blood vessel injury is extremely uncommon. Blood clots in the legs and lungs are also extremely uncommon. Infection is very uncommon. Progressive arthritis is inevitable as there is already damage to the cartilage in your knee. The regeneration procedures are aimed at alleviating pain and prolonging the longevity of your knee prior to joint replacement.