Cartilage integrity is difficult to restore once the cartilage has become worn. There are several surgical procures of relevance
Chondroplasty is a smoothing over of the cartilage – essentially removing any roughened edges, which could catch causing pain and tearing of further sections of healthy cartilage
Abrasion Microfracture
Small holes are made in exposed bone to encourage bleeding into the worn area. The blood contains progenitor cells which are able to grow into fibrocartilage (scar cartilage) this is better than bare bone but may not be as long wearing as the body’s original hyaline cartilage. When the area of wear is bigger (I follow the UK consensus guidelines here) I choose to perform a procedure called autologous matrix induced chondrogenesis (AMIC) where a membrane or Porcine scaffold (I use ChondroGide manufacturesd by Geistlich surgery in Switzerland) is glued over the microfractured bleeding bed. The cells from his blood are able to pass into the membrane, which acts like a scaffold to hold he cells in the correct positions whilst they grow into healthy cartilage. Where possible I try to perform this procedure with keyhole surgery but if this proves too fiddly or complicated then you may need a larger incision to access the area of damaged cartilage. I believe that I am one of the few surgeons in Britain who has performed this arthroscopically.
Chondroplasty is a smoothing over of the cartilage – essentially removing any roughened edges, which could catch causing pain and tearing of further sections of healthy cartilage
Abrasion Microfracture
Small holes are made in exposed bone to encourage bleeding into the worn area. The blood contains progenitor cells which are able to grow into fibrocartilage (scar cartilage) this is better than bare bone but may not be as long wearing as the body’s original hyaline cartilage. When the area of wear is bigger (I follow the UK consensus guidelines here) I choose to perform a procedure called autologous matrix induced chondrogenesis (AMIC) where a membrane or Porcine scaffold (I use ChondroGide manufacturesd by Geistlich surgery in Switzerland) is glued over the microfractured bleeding bed. The cells from his blood are able to pass into the membrane, which acts like a scaffold to hold he cells in the correct positions whilst they grow into healthy cartilage. Where possible I try to perform this procedure with keyhole surgery but if this proves too fiddly or complicated then you may need a larger incision to access the area of damaged cartilage. I believe that I am one of the few surgeons in Britain who has performed this arthroscopically.
