What is joint preservation?

Joint preservation (cartilage restoration) is a plethora of procedures in which a patient’s knee is resurfaced, realigned, and stabilized to preserve a deteriorating joint thereby avoiding or delaying joint replacement surgery. This problem is cause by damaged or deteriorating cartilage and/or misalignment of the knee. Every patient is different, so doctor will customize your joint preservation strategy with you based on your individual situation, taking into account factors such as your age, expectations, level of joint dysfunction, and activity level. 

What causes a cartilage injury/deterioration?

Most often cartilage injuries/deterioration happens in the knee joint. Cartilage injury/deterioration can also be due to arthritis in the knee. Cartilage injury can be due to a single traumatic event like a twisting non-contact injury and also it can be caused by low-impact repetitive injuries. 

How is a cartilage injury diagnosed?

Doctor diagnoses a cartilage injury after a thorough physical examination and review of your medical history. He may order imaging tests, including MRIs and X-rays, to get a further understanding of the workings inside your knee joint.

What are treatment options for joint preservation?

Treatment options address two important issues biomechanics and biology.

The biomechanics includes knee realignment and ligament reconstructions of the knee. Correction of misalignment improves biomechanics by correcting bowing or knocked knee deformities of the knee and this reduces loads on certain parts of the knee joint reducing pain. The biology forms of treatment are cartilage repair techniques that include Autologous Chondrocyte Implantation (ACI) and osteochondral allograft transplant (OATS).

With ACI procedure, cartilage cells are harvested from a non-weight bearing area of the knee and grown in a laboratory and then implanted in the area of the cartilage defect/injury.

With OATS procedure, autograft cartilage is used and it is obtained from the patient themselves from non-weight bearing part of the articular cartilage. The allograft can be shaped to fit the cartilage defect and is press fit into place.

Ortho-biologics like bone marrow aspiration concentrate(BMAC) and platelet rich plasma(PRP) are also viable options in the treatment of cartilage defects.