Osteochondral Allograft, Microfracture, OATS, and ACI Surgery of the Knee: Cartilage Restoration
Posted on 01. Jul, 2009 by Dr. Stefan Tarlow in Medical Insurance
The best treatment for a knee injury or disease Is one of biologic origins that restores the knee to a state near normal. ACL (anterior cruciate ligament) reconstruction, anatomic repair of knee fractures, and meniscal repair are three types of biological surgical repairs that are very successful for injured knees.
Orthopedists as well as patients often find managing a full-thickness, symptomatic chondral lesion of the knee to be problematic.
Injury that leads to articular cartilage cell death is well treated by restoration of the surface cells of the joint. The shiny white surface that composes all the joints in the body is the articular cartilage or surface cell layer of the joint.
This kind of tissue damage can be treated in four ways: Osteochondral Allograft, Autologous Chondrocyte Implantation (ACI), Osteoarticular transfer system (OATS), and Microfracture.
Click here for more on Arthroscopy of the Knee.
In a young patient, a small lesion can be treated with Microfracture surgery. In this method, a pick-like tool is used to enter the marrow of the knee under the chondral defect. Multiple entries stimulate the bone marrow, which, in turn creates repair tissue. This tissue fills the chondral defect with fibrous cartilage tissue.
In this situation, the patient will use crutches for four to eight weeks. The patient must agree not to participate in sports for 6 to 12 months. Also, the patient must understand and accept that it may be eighteen months before complete freedom of pain can be expected.
There is a procedure that can restore the knee surface to almost normal condition. This is called autologous chondrocyte implantation (ACI). This procedure is used in the case of large knee defects.
Articular cartilage cells can be harvested from the healthy part of the injured knee for utilization in ACI. There are very specific criteria that must be met for this surgery to be used.
Here are the surgical indications for ACI. First, the injury must be a full-thickness, symptomatic, weight-bearing chondral injury of the femoral articular surface. Second, the patient must be physiologically young. Third, the patient must agree to cooperate with the rehabilitation process for eighteen months.
Surgery to the tibia and patella may not be successful. For this reason, insurance companies often refuse payment for surgery of this type. ACI is not a workable procedure for treating osteoarthritis. This is a condition in which two reciprocal joint surfaces are damaged. X-rays show narrowing of the joint space, as well as bone spurs. The use of a 3T MRI (magnetic resonance imaging) can assess for ACI. This procedure can help determine the proper treatment.
Click here for more on Dr. Stefan Tarlow, an expert Phoenix surgeon of the knee.
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