Cartilage Reconstruction

What is Knee Cartilage Reconstruction?

Knee cartilage reconstruction, also known as cartilage repair or chondral restoration, is a medical intervention designed to treat defects or injuries to the articular cartilage in the knee joint. The articular cartilage plays a crucial role in the smooth and painless movement of the knee, as it acts as a cushion and provides a frictionless surface for the bones to glide on during motion.


Who is Suitable for Knee Cartilage Reconstruction?

Knee cartilage reconstruction is typically considered for individuals who have experienced cartilage damage in the knee due to various reasons, including:

  • Trauma
  • Osteoarthritis
  • Overuse or Wear and Tear
  • Genetic Factors
  • Meniscus Tears


Benefits of Knee Cartilage Reconstruction

Knee cartilage reconstruction offers several significant benefits for eligible patients, which can improve their overall quality of life, including:

  • Pain Relief
  • Improved Joint Function
  • Delaying or Avoiding Joint Replacement
  • Enhanced Mobility
  • Reduced Risk of Complications
  • Shorter Recovery Time


Types of Knee Cartilage Reconstruction

There are several types of knee cartilage reconstruction procedures, each tailored to address specific types of cartilage damage and individual patient needs. Here are some common types:

  • Microfracture: Microfracture is a minimally invasive procedure in which tiny holes are created in the bone beneath the damaged cartilage. This stimulates the growth of new cartilage. It is typically used for small cartilage defects.
  • Autologous Chondrocyte Implantation (ACI): ACI involves harvesting a small sample of healthy cartilage from the patient's knee, which is then cultured in a laboratory to grow more cells. These cells are later implanted into the damaged area of the knee to encourage cartilage regeneration.
  • Osteochondral Autograft Transfer System (OATS): In OATS, healthy cartilage and bone tissue are taken from a non-weight-bearing area of the knee and transplanted into the damaged area. This procedure is suitable for larger cartilage defects.
  • Osteochondral Allograft Transplantation: Allograft transplantation involves using donor cartilage and bone tissue to replace damaged cartilage. It is often used for large, complex cartilage lesions.
  • Autologous Matrix-Induced Chondrogenesis (AMIC): AMIC combines microfracture with the use of a biodegradable matrix that supports cartilage growth. This technique is used for intermediate-sized cartilage defects.


Preparation Before a Knee Cartilage Reconstruction

  • Consult with an orthopaedic surgeon who specialises in knee cartilage reconstruction. They will assess your knee condition, review your medical history, and conduct imaging tests such as MRI to determine the extent of cartilage damage.
  • Ensure you are in good overall health. Your surgeon may request various medical tests, such as blood work and cardiac evaluation, to ensure you are fit for surgery.
  • Your surgeon will discuss the different knee cartilage reconstruction options with you, considering the type and location of your cartilage damage. Together, you will decide on the most appropriate procedure.


Knee Cartilage Reconstruction Procedure

Here is a general overview of what happens during the surgery:

  • Anaesthesia: You will be given either general or regional anaesthesia to ensure you are comfortable and pain-free during the procedure.
  • Access to the Knee: Your surgeon will make small incisions around the knee joint to access the damaged cartilage.
  • Cartilage Repair: Depending on the chosen technique, your surgeon will either stimulate the growth of new cartilage, replace damaged cartilage with healthy tissue, or use a combination of approaches.
  • Closure: Once the cartilage reconstruction is completed, the incisions are closed with sutures or surgical staples.
  • Recovery Room: You will be monitored in a recovery room as the effects of anaesthesia wear off.


What to Expect After a Knee Cartilage Reconstruction?

Knee cartilage reconstruction is often performed as an outpatient procedure, meaning you can go home on the same day. However, some more complex procedures may require a short hospital stay.


Knee Cartilage Reconstruction Recovery Plan

  • Immediate Post-Op Phase (Days to Weeks):
  • You may need to wear a knee brace or use crutches to protect the surgical site and minimise weight-bearing on the affected knee.
  • Follow your prescribed pain medications as directed by your surgeon to manage discomfort.
  • Begin physical therapy exercises as recommended by your healthcare team. These exercises focus on maintaining joint mobility and preventing stiffness.
  • Early Rehabilitation Phase (Weeks 2-6):
  • Continue with physical therapy to gradually increase knee range of motion, strengthen muscles around the knee, and improve balance and stability.
  • Depending on your surgeon's guidance, you may gradually start bearing weight on the operated knee.
  • Avoid sudden movements or activities that may stress the healing cartilage. Your physical therapist will guide you on safe exercises.
  • Intermediate Phase (Weeks 6-12):
  • Your physical therapist will introduce more challenging exercises to build strength and stability.
  • Focus on achieving a normal walking pattern without limping or favouring the operated knee.
  • Under your surgeon's guidance, you can begin to reintroduce low-impact activities. High-impact activities and sports are usually restricted during this phase.
  • Late Rehabilitation Phase (Months 3 and Beyond):
  • Work with your physical therapist to build strength, flexibility, and endurance.
  • If you are an athlete, sport-specific training can be introduced as you progress.
  • Continue regular follow-up appointments with your surgeon to monitor your progress and make necessary adjustments to your recovery plan.


Knee Cartilage Reconstruction Prognosis

In general:

  • Many patients experience significant pain relief and improved knee function.
  • Early intervention and appropriate rehabilitation can lead to better outcomes.
  • Success rates are typically higher for smaller cartilage defects than for large, complex lesions.
  • Long-term success may involve ongoing care and monitoring to prevent future cartilage issues.


Knee Cartilage Reconstruction Risks

While knee cartilage reconstruction can offer significant benefits, there are potential risks and complications to be aware of, including:

  • Infection: Any surgical procedure carries a risk of infection. Signs of infection include increased pain, swelling, redness, and fever.
  • Failure to Heal: In some cases, the new cartilage may not integrate properly with the surrounding tissue, leading to persistent pain and limited function.
  • Blood Clots: There is a small risk of developing blood clots (deep vein thrombosis) in the legs after surgery, which can be a serious complication.
  • Nerve or Blood Vessel Damage: Surgical instruments and techniques can inadvertently damage nerves or blood vessels around the knee, leading to numbness or circulation issues.
  • Scar Tissue Formation: Excessive scar tissue (arthrofibrosis) can develop, limiting joint mobility.
  • Graft Failure: In procedures using grafts (such as allograft transplantation), the graft may not integrate or survive as expected.
  • Persistent Pain: Some patients may continue to experience pain or discomfort after surgery, especially if the underlying cause of the cartilage damage is not fully addressed.
  • Stiffness: Stiffness in the knee joint can occur, particularly if rehabilitation exercises are not diligently followed.


What if Knee Cartilage Reconstruction is Delayed?

Delaying surgery can allow cartilage damage to worsen, potentially making the reconstruction more challenging or less effective.


Prolonged delay may lead to ongoing pain and limitations in knee function, affecting your quality of life and ability to engage in activities you enjoy.

In some cases, if cartilage damage becomes too extensive, knee cartilage reconstruction may no longer be viable, and more invasive procedures like total knee replacement may be necessary.


It's essential to consult with an orthopaedic surgeon as early as possible if you suspect knee cartilage damage or are experiencing symptoms such as persistent knee pain, swelling, or limited mobility. Timely evaluation and intervention can often lead to better outcomes and a faster return to an active lifestyle.

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