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Cartilage restoration is an array of treatments and procedures designed to restore the natural lining of joints. The tissue covering the bones of our joints is Hyaline Articular Cartilage (“cartilage”). Unfortunately, cartilage has little or no ability to heal itself, so when damaged by injury or “wear and tear,” the resulting damage is permanent. A joint with injured, worn or diseased cartilage will typically be painful, and can experience aching, sharp pains, catching and grinding. Once cartilage is damaged, it typically worsens with time, limiting a person’s physical and recreational activities.
Cartilage restoration consists of a series of treatments, processes, procedures and implants designed to heal, and in some cases, repair and restore damaged cartilage. These treatments can biologically heal or restore the damaged joint with a combination of non-surgical and surgical treatments. For example, a non-surgical treatment might include injection of hyaluronic acid into the joint, whereas a surgical treatment might be a cartilage graft. Other examples of cartilage restoration can include using orthobiologic scaffolds to patch the joint, a juvenile donor cartilage transplant, fresh-stored osteochondral grafts, meniscal transplant, and the usage of growth factors and stem cells, among other therapies. Using biological therapies such as these can help to restore the joint to nearly normal, providing pain relief, enhanced function and hopefully, a long lasting solution.
In order for biological solutions such as these to restore cartilage, the joint must be restored to a properly aligned, stable and healthy environment. Therefore, many patients undergoing cartilage restoration have ligament stabilization surgery or realignment in conjunction with cartilage restoration procedures to maximize their chances of success.
Successful candidates for cartilage restoration tend to have “younger, healthier” bodies, not in terms of age, but rather health status. Your doctor will conduct an individual assessment to determine whether you are a candidate, evaluating xrays, scans, prior operative information, and conducting a physical exam. After gathering comprehensive information, your doctor can develop and implement an optimal individual treatment plan. This plan may involve preliminary arthroscopic surgery to measure and assess the joint and help prepare detailed plans to restore the cartilage.
If a joint’s mechanical environment, including alignment and stability, is normal or nearly normal, cartilage restoration is a viable option. However, for some patients, cartilage restoration is not possible. If the joint is badly arthritic, or has significant deformity, the solution may lie instead in what is called Joint Resurfacing, which uses metallic and synthetic components to allow patients with badly deformed or damaged joints to regain an active lifestyle and improve their functions. Read more about joint resurfacing in the section below.
Historically, damaged joints (primarily knees) in athletes have been treated by one of two methods: either arthroscopic “clean up” surgery, or total joint replacement. However, many people do not get sufficient relief from a “scope clean up” and are not appropriate candidates for a “total joint.” Total joint replacement provides excellent relief from painful arthritis, but surgery is extensive, and has its limitations. For example, total joints have a limited life-span (10-20 years), and high-impact sports are not recommended on a traditional total joint. Regular athletic use can shorten the expected longevity of a traditional total joint, so this may not be an ideal solution for younger, active or athletic people. In addition, a total knee replacement involves sacrificing all the internal ligaments, as well as quite a bit of bone: cutting off the end of the femur, back of the patella and top of the tibia. This is a highly invasive procedure that limits any future options should the prosthesis wear out or come loose.
Alternatively, the field of Joint Resurfacing is a new approach that offers very attractive and exciting alternatives for active adults with joint damage and pain. This approach focuses exclusively on resurfacing or replacing only the damaged parts of the joint, while preserving and retaining all the healthy bone and tissue. It leaves the joint feeling and working more normally. The patient retains an improved sense of balance and position, allowing a return to all sorts of athletics, and activities which would otherwise be painful or impossible.
There are different forms of joint resurfacing, and these may be combined with each other as well as some cartilage restoration techniques. The least invasive method is an “inlay.” Inlay resurfacing is very much like replacing damaged tiles on a tile floor. Rather than ripping out the whole floor to repair a broken or damaged tile (the cartilage) the local area can be resurfaced with an implant specifically contoured to that region of the joint. Inlay implants come in a variety of shapes and sizes. While these implants are very useful, they are limited in terms of what kind of deformities they can repair. Once the joint becomes crooked or deformed, we typically resort to using an “onlay” resurfacing implant. Onlay implants cover the ends of the damaged joint, allowing a normal angle and position to be reestablished while providing a new, smooth surface. Like inlay implants, onlays come in a variety of shapes and sizes.
Even with these modern methods, however, when all three parts of the knee are deformed and the knee is limited in motion, a modern total knee replacement may be necessary and can be an excellent alternative. Unlike traditional procedures, a modern total knee replacement now utilizes digital information technology to precisely pre-plan the procedure. Using this technology, the entire limb is digitized and a preoperative plan is developed to create guides for precise cutting and sizing. In addition, modern materials used for today’s total joint replacements allow many athletes to return to activities such as skiing, hiking, biking, tennis, equestrian, and other limited impact sports.
Sports medicine orthopedics involves incorporating the most modern, advanced surgical and rehabilitation techniques to optimally return injured athletes to their sports and active lifestyles. Many active people sustain injury to knees or shoulders. How these injuries are diagnosed and treated is critically important and very different among health care providers. Sports medicine physicians are particularly skilled in using surgical skills to facilitate the optimal return to sport and activity for their active patients following a knee or shoulder injury. This includes prompt diagnosis, cutting edge treatments and surgery, and interactive rehabilitation.
Two very common sports injuries are tears to the ACL (knee) and the rotator cuff (shoulder). For active people, the proper diagnosis, repair and rehabilitation of these injuries will make a world of difference in the patient’s ability to return to an active lifestyle. The skill of an experienced sports medicine specialist is critical to the patients’ successful recovery and ultimate outcome.
ACL injury is a common knee ailment in athletes. A physical exam by an experienced knee surgeon, combined with specifically selected imaging techniques, can yield a precise and detailed diagnosis, allowing comprehensive and ideal treatment from the outset. For example, where standard MRI imaging has limited ability to see articular cartilage, a sports medicine specialist may use 3T MRI imaging to visualize cartilage damage, yielding important information that guides treatment. Once the diagnosis is made, selecting the most appropriate and effective reconstruction graft is vitally important. Depending upon the patient’s age, health and prior surgical history, grafts can be taken from the patient, the tissue bank, or a combination of these. In addition, the usage of growth factors and stem cells can accelerate healing from ACL reconstruction. The most skilled sports medicine physicians expertly use these and other techniques.
Rotator Cuff injury can lead to pain at rest as well as with activity. Once torn, this shoulder tendon has little or no capacity for self-healing, because it is under tension and retracts accordingly. Repair of a torn rotator cuff is time-sensitive, but prompt diagnosis and treatment will typically lead to positive outcomes. Once a tear is identified, the technique selected to repair the injury is critical to successful repair, recovery and restoration of strength. Advanced techniques, many of which are performed arthroscopically, include a two-row anatomic repair, locking support anchors and special suturing configurations. In addition, biological augmentation can promote more rapid healing and recovery. The use of platelet-rich plasma, growth factors and stem cells can all promote recovery in certain situations. The return to athletics following a rotator cuff injury is dependent on a host of factors, including prompt, comprehensive diagnostics, cutting edge surgical techniques and coordinated post-operative therapy. A sports medicine specialist brings this expertise to optimize the patent’s healing.
For active people and athletes, a sports medicine orthopedic specialist is critical for a successful return to sport and an active lifestyle.