Definition of articular cartilage of the knee:
There are three bones in the knee joint and the ends of these bones are covered with
a tough, smooth, white elastic tissue called articular cartilage. This material helps absorb shock and it is what allows the knee joint to move smoothly.
Symptoms of articular cartilage injury:
Damage and injury to articular cartilage of the knee is relatively common in runners. We also seen this type of injury in skiers, cyclists, and athletes in various sports that are hard on the knees. The most frequent symptom is a dull pain around or under the knee cap that worsens when walking down stairs or hills. A person may also feel pain when climbing stairs or when the knee bears weight as it straightens. The disorder is common in runners and is also seen in skiers, cyclists, and soccer players.
Causes of articular cartilage injury:
Occurring most often in young adults, this injury can be caused by overuse, malalignment, and/or muscle weakness. Articular cartilage of the knee allows the knee cap to glide smoothly over the bones underneath. However, with overuse, malalignment or muscle weakness, the knee cap rubs asymmetrically against the femur, grinding the cartilage underneath.
Articular cartilage injury diagnosis:
A patient’s description of symptoms with an X-ray and possibly an ultrasound, usually helps the doctor make a diagnosis.
At the West Coast Center for Orthopedic Surgery and Sports medicine in Manhattan Beach, Los Angeles, CA, we go beyond the typical temporary pain-relief measures and we strive to avoid invasive surgery whenever possible. The specific treatment will take into consideration the patient’s age and lifestyle. For many older patients, there are alternatives to full knee. For younger, more active patients, we look for less invasive treatment options that avoid longterm problems, degenerative arthritis and scar tissue.
Under the direction of Keith S. Feder, M.D., Board Certified Orthopedic Surgeon and Medical Director of The West Coast Center for Orthopedic Surgery and Sports Medicine, we have had great success with Autologous Chondrocyte Implantation (ACI). This is a new surgical technique developed in Sweden by Dr. Lars Pederson. ACI requires two minimally invasive procedures. The first is an outpatient arthroscopic procedure to remove (or biopsy) a small portion of the patient’s normal articular cartilage. This biopsy is sent to a lab where the patient’s own cartilage cells are grown. Approximately one month later, the cells are re-implanted into the knee through a small incision. A flap is sewn as a roof over the cartilage defect and the cultured cartilage cells are injected into the defect under this periosteal flap.
After the procedure, the patient remains on crutches for approximately 2 months and uses a continuous passive motion machine (CPM) immediately after surgery to maintain knee motion and help the cartilage cells mature. To allow for a full recovery and best results, we strongly recommend that the patient does not return to impact-loading sports until at least 9-12 months after the second surgery.
This procedure is currently offered at the West Coast Center for Orthopedic Surgery and Sports medicine in Manhattan Beach, Los Angeles, CA. ACI is not indicated for generalized knee arthritis but rather for isolated articular cartilage defects of the femur and patella (knee cap). The ideal patient is a younger patient (under 60 years of age) who has developed an isolated lesion following a traumatic injury or from a developmental problem such as osteochondritis dissecans.