What is cartilage transplantation?
Cartilage transplantation is a treatment to replace damaged areas of cartilage as a result of specific injuries. It is very common in lower extremity injuries. To be effective, the damaged area must have a maximum extension of three square centimeters. The anesthesia used in cartilage transplant surgery is usually local, only applied to the injured leg. In any case, it will be the anesthesiologist who will agree with the patient the best way to proceed, in order to cause the patient the minimum discomfort during the intervention.
The aim of cartilage transplantation is that it integrates perfectly with the neighboring tissues in the joint.
with the neighboring tissues in the joint and restore its function.
Why is it performed?
Cartilage transplantation is mainly used in cases of ankle and knee cartilage damage. Bone and cartilage pieces or cartilage cells are usually implanted directly in heavily loaded areas or cartilage cells are cultured.
Cartilage is a very important tissue, which provides dynamism to the joints. It covers the ends of the bones and has a great capacity to support, distribute and transmit compressive forces to which the joints are subjected on a daily basis or during sports practice. The joint contact part is smooth at the ends and, in addition to the low friction of the cartilage, it is very well lubricated, thus reducing friction between surfaces. However, in spite of being very useful, cartilage has a big problem if it is injured, and that is that in the event of a traumatic or degenerative injury it has little or no capacity for repair, which leads to osteoarthritis and loss of joint function.
The objective of cartilage transplantation is that the implanted material is equal to the articular cartilage it replaces, reducing degenerative traumatic injuries. In this way it will integrate perfectly with the neighboring tissues in the joint and restore the articular friction surface.
What does it consist of?
Cartilage transplantation is performed by means of arthroscopy, that is, through 2 or 3 small incisions of no more than one centimeter that allow the surgeon specialized in traumatology to access the lesion. With the arthroscopy the injured part of the joint will be extracted. Thus, with special material, pieces of bone and cartilage will be removed from the worn areas of the joint and implanted in the injured area. As a compensatory measure, the damaged area can be implanted in the healthy part to counteract the overload.
In cases of autologous cartilage transplantation, the damaged area is smoothed and the cartilage material is extracted for use in the patient himself. This cartilage must be cultured for about four weeks. After this period, the cultured cartilage cells are implanted again, in a second arthroscopy, so that they can grow and repair the lesion.
Preparation for cartilage transplantation
Before undergoing a cartilage transplantation operation, the traumatology specialist must assess the severity of the injury. The radiographic study will be the main technique used to diagnose traumatic knee injuries. Likewise, teleradiographs will identify any alterations in the axis of the legs that may require repair of the lesion. However, it is not always visible. In such cases an MRI will be necessary, which will show not only the condition of the knee cartilage but also whether there are associated lesions.
On the other hand, the patient must also inform the surgeon of any medication he/she is taking that may, at some point, interfere with the operation. In addition, some preoperative tests will be performed to assess the patient’s state of health, such as an electrocardiogram or blood tests, among others.
Care after the operation
After the operation, the patient must follow the recommendations of the orthopedic surgeon so that the knee injury recovers correctly. After surgery, it is normal for the knee to be swollen, so it is recommended that the patient keep his or her leg elevated for the first few days. If the patient applies ice to the operated area it will also reduce the inflammation.
On the other hand, it is important to care for, clean and dry the incisions. The specialist will tell the patient how to proceed and when he/she will be able to shower and change the bandage.
At the same time, the traumatologist and the specialist in physiotherapy will design a series of rehabilitation exercises customized to the patient and the injury he/she is suffering. This will progressively restore the flexion-extension and rotation movement of the knee, as well as strengthen the muscles again.
Alternatives to this treatment
The aim of the cartilage transplant operation is for the implanted tissue to integrate perfectly with the other tissues of the knee joint. In recent years, different procedures have been developed to repair cartilage lesions, such as the use of chondrocytes and other cells, combined with biological therapies such as tissue engineering and gene therapy. This suggests that, in the future, the regeneration of knee injuries may be possible.
However, these injuries are difficult to cure, with little regenerative capacity with current techniques, so prevention and cartilage transplantation are the most favorable solutions.