Surgery at Knee and Shoulder India
There are three cell stimulation techniques used to treat articular cartilage injury:
Arthroscopic debridement – Also known as chondroplasty, the procedure uses a tiny camera which is inserted into the area of the knee joint to visualize it and clean it up. The rough edges are trimmed and loose fragments removed. The technique is ideally a short term solution.
Microfracture – With the help of a blunt awl tiny holes are made in the bone right under the cartilage. This process induces a healing response due fresh blood supply into the area to form new cartilage.
Abrasion arthroplasty – When the articular cartilage wears away, the bone surfaces rub against each other causing hardening and polishing of the surface of the bone. A burr is used to conduct an abrasion arthroplasty where the hard and polished bone tissue is scraped off triggering a healing response of the bone. New fibrocartilage is formed as blood vessels enter the area.
The following restorative surgeries are conducted:
Autologous chondrocyte implantation – Features
Generally done in patients aged between 20 and 50 years
Complete restoration of the structure of the articular cartilage
Lesion is small in size – < 4 cms in diameter and hasn’t damaged badly
New cartilage is implanted into the knee
A small flap of tissue is used to cover it
Healing process helps in holding the cells in place and attach themselves around the cartilage
Osteochondral allograft – Similar to the osteochondral autograft tissue is extracted from an external source instead of the patient’s own body. Large particles of bone and cartilage are placed over the joint and attached with screws. The success rate of this surgery is generally very high.
Osteochondral autograft – The osteochondral autograft much like the allograft involves placing small amounts of bone and cartilage taken from the donor site – in the patient’s own body. OCD or osteochondritis dissecans is treated successfully with osteochondral autograft.
Periosteal and perichondral grafting – Tissues covering the bone and the cartilage are implanted into the lesion. An articular cartilage is actually formed rather than a weak fibrocartilage. Periosteal and perichondral grafting are still procedures that are under research.