Cartilage Injury

Due to its lack of blood supply, when injured cartilage does not heal well, if at all. Children are more likely to recover from a cartilage injury because their cartilage is more resilient.

The patella femoral joint is the joint between the kneecap and the large bone of the lower leg, the femur. A patella-femoral cartilage tear is a difficult problem to treat. Physiotherapy is often recommended to strengthen the quadriceps muscles that support the knee joint.

Dr. Alan Nasar performs a Cartilage Transplant Knee Surgical Technique for knee cartilage injury. The procedure is known as the Carticel procedure.  This procedure involves growing your own cartilage externally from your body and then implanting it back to repair the injury. The technical name for this operation is A C I which stands for autologous chondrocyte implantation. Carticel is suitable for young patients, unfortunately I do not fall into this category but I was advised by Dr Nasar that I may be a candidate for the operation because I am not obese, do not smoke, have no systemic disease and other such risk factors. The only problem is that it is quite an expensive operation, it is not quick and there are some risks. It is being improved all the time, I guess, so hopefully the cost will come down the treatment outcomes improve.

Cartilage repair

There are two main kinds of cartilage, hyaline cartilage and fibro cartilage. Hyaline cartilage is found on the articular surfaces of joints. Fibrocartilage is found in areas such as the meniscus. Essentially there are 2 main kinds of cartilage repair, the ACI type operation as described above and microfracture (MF). Microfracture involves creating a very small fracture in the underlying bone in order to stimulate cartilage regrowth. ACI produces cartilage that is described as hyaline like i.e. it is like hyaline cartilage but it is not exactly the same. In studies microfracture and ACI are both roughly equal in their effectiveness but ACI is significantly more expensive. There is also some evidence that if you have had microfracture ACI is less likely to be effective. Currently ACI is not available on the NHS though MF is. I had debridement and microfracture performed on my hip joint in 2006 and so far this has been quite successful, though it has not completely restored my joint to what it was before the injury. (The operation that I had done was undertaken to address femoral acetabular impingement which also involves removing a little bit of the bone that is irritating the cartilage. It was performed by Mr Damian Griffin in Coventry).