Articular Cartilage Surgery Overview
The most commonly performed articular cartilage surgery techniques for chondral defects are chondroplasty (cartilage removal), microfracture (holes made in bones that release stem cells from the marrow), and Osteochondral autograft transfer system (OATS) surgery. Dr. Peter Millett will choose the appropriate chondral defects surgery based on size of the defect, as well as the location in the knee, age and weight of the patient, activity level of the patient, and other assessments surrounding the medical condition of the knee.
Chondral Defects Surgery Techniques
Shaving or Debridement Surgery
During this arthroscopic surgery, Dr. Millett will smooth the shredded or frayed articular cartilage. This common treatment is intended for patients who have cartilage defect that has not worn down to bone. It leads to satisfactory results in over 75% of patients. For patients with arthritis and osteoarthritis, this articular cartilage surgery works well when other resurfacing techniques are not appropriate. Ideally, the smoothing and shaving away of the damaged cartilage helps to ultimately decrease friction and irritation, thus reducing the symptoms of swelling, noise, and pain.
Microfracture is a well-accepted and successful technique that encourages the growth of new cartilage into the knee chondral defect. This procedure is performed arthroscopically and is a common knee surgery for patients with damage through the full thickness of articular cartilage (down to bone).. During the surgery, the base of the damaged area is scraped to create a bed of bleeding bone. Causing the bone to bleed is useful because intrinsic properties of blood help with healing. Dr. Millett will then poke very tiny holes into the defect with a special instrument. This promotes blood vessel and bone marrow growth inside the defect and can lead to the production of new fibrocartilage. This technique is most useful in treating smaller cartilage defects.
OATS, osteochondral autograft transfer system, is a technique that involves replacing damaged joint cartilage (in high weight bearing areas) with healthy cartilage and bone (from lower weight bearing areas). This is an arthroscopic or open procedure done using either one’s own healthy tissue or tissue transplanted from a cadaver. Small holes are drilled into the damaged cartilage area. Then, bone and cartilage grafts are inserted into the defective area to re-surface the damaged cartilage. It is highly effective.