Chronic Joint Pain and Cartilage Regeneration
By Dr Ram Mohan Reddy Venuthurla, Senior Consultant Orthopaedic Surgeon
"Cartilage is a connective tissue layer that acts as a shock absorber (cushion) and decreases the friction between the bones of a joint. Lubrication of the joint is done by synovial fluid produced by the membrane lining the joint. The joint gets painful, swollen with restriction of movements when the cartilage gets damaged. In severe cases with complete loss of joint space, total joint replacement surgery is indicated. Advances in technology now allow the damaged cartilage to be regenerated by using the body’s cells to regrow new cartilage."
These regenerative treatments are usually administered by arthroscopy (keyhole surgery). The surgery greatly decreases recovery time and complications by using small incisions. Sometimes bigger incisions are needed to properly expose the damaged cartilage for treatment.
Currently, some of the procedures that are used for cartilage repair include arthroscopic (key hole surgery) debridement. This is performed with removal of the unstable damaged cartilage and stabilization of the healthy cartilage margins. This is not a permanent cure but helps to reduce the symptoms to a certain extent
Micro-fracture surgery is another technique performed for injuries smaller than 2cm2. In this procedure, multiple tiny holes are punched into the underlying bone, a stem-cell rich clot forms structure called fibrocartilage at the damage site and this material repairs the damaged cartilage by filling in the gaps.
Autologous Chondrocyte Implantation (ACI) is a two-step procedure that takes several weeks. It is generally recommended for younger patients with single defects larger than 2cm2. The procedure begins with obtaining and growing healthy cartilage cells from a structurally reclusive area of the knee. These cells are later surgically implanted into the damaged area.
In Matrix-Induced Autologous Chondrocyte Implantation (MACI) procedure, articular cartilage damage is repaired using self-cartilage cells just like in ACI. But the cells are now expanded on a membrane and a few weeks later this membrane is implanted at the damaged site.
Osteochondral autograft transplantation is a graft of healthy bone and tissue from the patients' unaffected joint to the damaged area. These are called plugs, and multiple plugs form a mosaic at the transplant site earning the name mosaicplasty.
Mesenchymal Stem Cells (MSC) can form bone, cartilage, muscle and adipose tissue cells. They are found in the bone marrow and adipose tissues etc. These are employed to repair cartilage and have shown promising results in research and human clinical trials. However, before using stem cell therapy routinely long term studies are needed.
After repair procedures, patients are advised to reduce pressure on the cartilage by using crutches for at least two months. Complete recovery could take up to 3 to 6 months. You must consult a specialist if you are suffering from chronic knee or joint pains and discuss the available treatments to find which will be the most beneficial in your case.
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Dr Ram Mohan Reddy Venuthurla ,
Senior Consultant Orthopaedic Surgeon
Disclaimer: : The views and opinions expressed in this article belong solely to the author. They do not reflect the opinions or views of the organization.