Damage to articular cartilage
When there is damage to the articular cartilage (the cartilage that lines the bone and forms the joint surface) this could be a pre-cursor for the development of arthritis.
Articular cartilage damage in someone who is young (less than 40 years) is a difficult problem to manage. The reason for this is that your own body cannot make new articular cartilage, and although laboratories can make cartilage it is not like articular cartilage. Any operation that Nigel does, again will not regenerate the articular cartilage that you have lost. What your body makes is a form of cartilage and the expectation is that the formation of new cartilage will settle down your symptoms such that you can perform all daily activities and participate in low impact sports activities.
After talking with you, examining your knee, x-ray and MRI review, Nigel will give you a thorough understanding of your condition and then make recommendations on what non-surgical options are available or he may elect to undertake one of the following operations:
- Autologus Chondrocyte Implantation (ACI)
- Matrix-induced Autologus Chondrocyte Implantation (MACI)
- OsteochondralAutologus Transfer System (OATS / Mega-OATS)
- Osteochondral Chondral Allograft (OCA)
Nigel will discuss with you what is the most appropriate form of treatment. Everyone is different and treatment has to be tailored for each patient.
Normal Articular Cartilage
When Nigel does an arthroscopy, articular cartilage is gleaming, shiny, smooth and white in colour. Interestingly it is 16x slipperier than ice. There are no rough edges, no fraying, no fibrillation of normal articular cartilage. The arthroscopy photo below shows what a normal medial (inside) compartment looks like. F=femur, T=tibia, MM=medial meniscus
Damaged Articular Cartilage
Articular Cartilage damage takes many different forms and can occur anywhere in the knee joint where articular cartilage is. The arthroscopy photo below on the left is in the trochlea groove (the groove on the femur that the patella runs in). The photo below on the right shows the medial femoral condyle - MFC (inside part of the knee) with cartilage loss. Beneath the thin blue line demonstrates an area of cartilage loss and above the thin blue line demonstrates cartilage but this cartilage is not normal either.
The arthroscopy photo below on the left shows a loose piece of cartilage (LC) that has broken off and is floating around the knee.When this photograph was taken it was in the patello-femoral joint (knee cap joint). At times, pieces of cartilage cause a “jamming” sensation in the knee.
The arthroscopy photo below on the right shows where that piece of cartilage has come from, with exposed bone (EB) with loss of cartilage from the lateral (outside) compartment of the knee. The blue arrow is pointing to a flap of cartilage. F=femur, P=patella