Runner in mid-stride running up a mountain

To understand the treatments for cartilage and meniscus repair, it’s helpful to understand how each functions. Cartilage is the rubber-like padding that coats our bones and allows them to glide at the joints. The meniscus is a type of cartilage that forms a shock absorber between the bones. Because cartilage and meniscus tissues lack blood vessels and nerve endings, they are difficult to repair once they are injured or damaged. Damaged cartilage can limit your range of motion preventing you from bending your knee or straightening your leg completely.

For example, when you have arthritis in your knees, the cartilage often becomes thin. Since cartilage can't regrow, a lack of cartilage often plays a major role in knee joint malfunctions and knee pain — and may subsequently lead to joint replacement.

However, at Penn Medicine, there are options to ease your pain and prevent or delay the onset of arthritis which may delay having your knee replaced. We offer the most advanced and effective cartilage repair and restoration options available in the Philadelphia region, including cartilage transplantation which repairs defects with your own cartilage cells.

The Cartilage and Meniscus Repair Surgery Process

Once our orthopaedic surgeons review your x-rays and other reports, they will recommended the best treatment option depending on the extent of damage, size and location of the tissue defect.

Small defects in specific locations may be treated using an osteochondral autograft transfer or microfracture, which can be performed with smaller incisions.

Large defects may require treatments such as autologous chondrocyte implantation or fresh osteochondral allograft transplantation.

Penn Sports Medicine surgeons are specially trained to perform these procedures along with ligament reconstruction as needed.

Types of Cartilage and Meniscus Repair Surgeries

Autologous Chondrocyte Implantation (ACI)

This procedure is recommended for younger, active patients with certain cartilage injuries or defects smaller than two centimeters in diameter. ACI relieves pain while also slowing the progression of cartilage degeneration and potentially delaying partial or total knee replacement surgery. At Penn Medicine, our orthopaedic surgeons use the patient’s own cartilage cells to repair the damaged area.

ACI is a two-stage treatment.

The first stage is done arthroscopically (only two small incisions are made). A biopsy of cartilage is harvested and sent to a lab where they grow millions and millions of your own cells. When complete, the lab sends back a collagen membrane seeded with your own cells and is prepared for the second part of surgery.

In the second stage, an incision is made long enough for access to the injury site, where the collagen membrane is implanted and secured with glue and possibly suture. The cells mature over time — as long as 18 months — and become cartilage.

Osteochondral Autograft Transfer

Similar to ACI, this is a procedure for a small cartilage defect that transfers a cartilage graft from a non-weight bearing area of the joint to the defect. The graft is matched to the defect and impacted into place, leaving a smooth surface. In many cases, this procedure is performed arthroscopically.

Osteochondral Allograft Transplantation

This procedure is most effective for younger, more active patients with a large disabling cartilage injury or disease in the knee or ankle, where a tissue graft is taken from a donor that is sized and shaped to fit the defect. Once in place, the graft is pressed to fit into the damaged site.

Osteochondritis Dissecans

Osteochondritis dissecans is caused by a separated fragment in the knee becoming avascular and existing as a loose body within the joint. For pieces that can be saved, bone grafting and fixation with screws is typically the lead option to save these fragments.

For pieces that cannot be saved, bone grafting and autologous chondrocyte implantation is an excellent biologic treatment option and allows people to return to combat sports, collision sports and contact sports. Penn has performed this procedure for many, many years with very high success rates.

Microfracture

This procedure is a technique used to stimulate the growth of new articular cartilage by creating a new blood supply. This is achieved by creating tiny fractures in the joint surface and allowing marrow elements to reach the joint surface to create new cells that form the new cartilage. This procedure can be done arthroscopically.

Meniscal Allograft Transplantation

This type of procedure is technically demanding and requires specialized expertise. We take a size-matched donor (cadaveric) meniscus and place it in the patient arthroscopically. The new meniscus provides support and acts as a shock absorber. This procedure, which can help knee pain and possibly prevent arthritis, is only performed in cases when most of the meniscus cartilage must be removed. Before meniscal transplantation, the meniscal deficient knee did not have a treatment option.

Arthroscopic Meniscal Tear Repair

Using an arthroscope (a thin flexible scope used to visualize the joints in the knee) surgeons perform this procedure by creating a few small incisions in the knee. They will then place other instrumentation inside the knee to remove the torn cartilage. The arthroscope enables surgeons to look closely at the knee joint for signs of arthritis, loose cartilage and other problems. Incisions are very small (about 1 centimeter) and are closed with stitches that are placed inside or outside of the knee.

About the Penn Center for Advanced Cartilage Repair and Osteochondritis Dissecans Treatment

The Penn Center for Advanced Cartilage Repair and Osteochondritis Dissecans Treatment is recognized as one of the pre-eminent cartilage restoration centers nationally — becoming #3 in the nation for volume of autologous chondrocyte implantation surgeries.

Our orthopaedic team is highly experienced in cartilage repair, meniscal transplantation and osteochondritis dissecans treatment. Our surgeons and researchers are committed to developing new technology to make meniscus treatment and cartilage repair safer and more reproducible.

Each member of our orthopaedic team is highly experienced in cartilage repair, meniscal transplantation and osteochondritis dissecans treatment. This includes our nurses who triage patients and our nurse practitioners and our physician assistants who evaluate each case. As a team, we arrive at optimal treatment plans designed just for you.

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