Introduction
Surgical repair of cartilage is aimed at restoring damaged or degenerated cartilage to alleviate pain, improve joint function, and delay the progression of conditions like osteoarthritis. These procedures are commonly performed in weight-bearing joints like the knee but can also apply to other joints such as the hip, ankle, and shoulder.
Surgical Repair Options available here in Singapore
Microfracture/Nanofracture
Osteochondral Autograft Transfer (OATS)
Osteochondral Allograft Transplantation
Autologous Matrix Induced Chondrogenesis (AMIC)
Arthroscopic Debridement and Lavage
Microfracture/Nanofracture
- Procedure: Small holes are drilled into the subchondral bone to stimulate the release of bone marrow cells.
- Goal: Promote the formation of fibrocartilage, a less durable substitute for hyaline cartilage.
- Indications: Small, focal cartilage defects in younger patients.
- Limitations: Fibrocartilage lacks the durability of natural hyaline cartilage.
Osteochondral Autograft Transfer (OATS)
- Procedure: Healthy cartilage and underlying bone are taken from a non-weight-bearing area of the joint and transplanted into the damaged area.
- Goal: Restore the defect with native hyaline cartilage.
- Indications: Small-to-moderate cartilage defects.
- Limitations: Limited donor tissue availability.
Osteochondral Allograft Transplantation
- Procedure: Uses cartilage and bone from a donor to repair larger defects.
- Goal: Cover extensive damage with viable, mature cartilage.
- Indications: Large or complex cartilage injuries unsuitable for autografts.
- Limitations: Availability of donor tissue and risk of immune response.
Autologous Matrix Induced Chondrogenesis (AMIC)
- Procedure: Minimally invasive cartilage repair technique that combines microfracture/nanofracture surgery with the use of a bioresorbable collagen scaffold to enhance cartilage regeneration.
- Goal: After preparing the defect and performing microfracture to release mesenchymal stem cells (MSCs) from the bone marrow, a scaffold is placed over the area to support cell attachment and growth, promoting the formation of hyaline-like cartilage.
- Indications: AMIC is suitable for medium-sized cartilage defects, particularly in younger and active patients, and offers improved outcomes compared to microfracture alone.
Arthroscopic Debridement and Lavage
- Procedure: Removal of loose cartilage fragments and smoothing of rough edges.
- Goal: Temporarily reduce symptoms (mechanical) rather than repair cartilage.
- Indications: Early-stage cartilage damage or when other options are not suitable.
- Limitations: Short-term relief without long-term regeneration.
Microfracture/Nanofracture
Osteochondral Autograft Transfer (OATS)
Osteochondral Allograft Transplantation
Autologous Matrix Induced Chondrogenesis (AMIC)
Arthroscopic Debridement and Lavage
Microfracture/Nanofracture
- Procedure: Small holes are drilled into the subchondral bone to stimulate the release of bone marrow cells.
- Goal: Promote the formation of fibrocartilage, a less durable substitute for hyaline cartilage.
- Indications: Small, focal cartilage defects in younger patients.
- Limitations: Fibrocartilage lacks the durability of natural hyaline cartilage.
Osteochondral Autograft Transfer (OATS)
- Procedure: Healthy cartilage and underlying bone are taken from a non-weight-bearing area of the joint and transplanted into the damaged area.
- Goal: Restore the defect with native hyaline cartilage.
- Indications: Small-to-moderate cartilage defects.
- Limitations: Limited donor tissue availability.
Osteochondral Allograft Transplantation
- Procedure: Uses cartilage and bone from a donor to repair larger defects.
- Goal: Cover extensive damage with viable, mature cartilage.
- Indications: Large or complex cartilage injuries unsuitable for autografts.
- Limitations: Availability of donor tissue and risk of immune response.
Autologous Matrix Induced Chondrogenesis (AMIC)
- Procedure: Minimally invasive cartilage repair technique that combines microfracture/nanofracture surgery with the use of a bioresorbable collagen scaffold to enhance cartilage regeneration.
- Goal: After preparing the defect and performing microfracture to release mesenchymal stem cells (MSCs) from the bone marrow, a scaffold is placed over the area to support cell attachment and growth, promoting the formation of hyaline-like cartilage.
- Indications: AMIC is suitable for medium-sized cartilage defects, particularly in younger and active patients, and offers improved outcomes compared to microfracture alone.
Arthroscopic Debridement and Lavage
- Procedure: Removal of loose cartilage fragments and smoothing of rough edges.
- Goal: Temporarily reduce symptoms (mechanical) rather than repair cartilage.
- Indications: Early-stage cartilage damage or when other options are not suitable.
- Limitations: Short-term relief without long-term regeneration.
Factors Influencing Choice of Repair
- Patient’s age, activity level, and overall health.
- Size, location, and severity of the cartilage defect.
- Surgeon expertise and available resources.
Prognosis
While cartilage repair techniques can improve joint function and reduce pain, complete restoration of natural cartilage is challenging. Success and long term durability often depends on early intervention, adherence to rehabilitation protocols, and patient-specific and cartilage defect factors.
