The Rush Cartilage Restoration Center (CRC) uses the latest minimally invasive techniques to repair, preserve and replace damaged cartilage.
New Approaches to Preserving, Restoring and Replacing the Meniscus
In addition to the white glistening articular cartilage that coats the ends of our bones in our joints, the meniscus is another important cartilage structure that prevents then onset or progression of arthritis (cartilage breakdown). Meniscus cartilage is composed of elastic, smooth and dense connective tissue that can help bones absorb shock and allow joints to move smoothly. These two pads of cartilage provide a cushion in the knee joint connection between the thighbone (femur) and the shinbone (tibia). They are crescent-shaped discs that act as shock absorbers, provide protection to the knee joint from the weight of the body and enhance stability and mobility. The meniscal cartilage allows the knee joint to withstand the day-to-day pressures placed on it by walking, running, sitting and standing.
Preserving the meniscus
Surgeons repair the meniscus whenever possible, removing only the portions that are considered beyond repair. In the past, the first line of treatment for such injuries was complete removal of the meniscus. This could lead to problems later in life, including early development of arthritis. Today, we recognize the protective value of the meniscus and do everything we can to repair or replace it.
Replacing the meniscus
For patients who have had the meniscus completely removed in a previous surgery, the missing meniscus can be replaced with a human meniscus transplant. Unlike other forms of tissue transplantation, this procedure does not require patients to be on medications to prevent tissue rejection. To replace meniscus cartilage, surgeons can sew in a new meniscus that heals and functions much like it was the patient’s own. This leads to a more stable and less painful knee that might otherwise have developed progressive arthritis. At the Rush CRC, Dr. Cole has developed in collaboration with Dr. Farr from Indianapolis specialized instrumentation to more easily and reliably perform a meniscus transplant in an outpatient surgical setting using a minimally invasive arthroscopic procedure.
Restoring the meniscus
Dr. Cole is actively involved in research that utilizes a collagen meniscus implant to replace part of the damaged meniscus, when it cannot be repaired. Over time, the implant is replaced by the body’s own meniscus cells and is naturally reabsorbed, leaving new meniscus tissue in its place. The collagen implant is designed to provide a biocompatible and bioreabsorbeable bridge for new tissue growth.
New Approaches to Repairing Articular Cartilage
Articular cartilage is a particular type of cartilage that covers the ends of bones and protects them from damage, reduces friction and allows for smoother movement of the bones in the joint.
Early intervention – arthroscopic debridement
Aided by a small camera (arthroscope) and using specialized surgical instruments, surgeons can locate damaged tissue and trim away areas of torn cartilage and remove the damaged tissue to reduce knee pain and improve knee function.
Early intervention – arthroscopic microfracture
Aided by the arthroscope, surgeons create small holes in the uncovered bones – called microfractures – which then assist the cartilage defects in healing by forming a type of cartilage covering that resembles normal articular cartilage.
Autologous cartilage cell implantation (ACI)
Also called autologous chondrocyte implantation, or ACI, this is one of the most advanced techniques for cartilage regeneration. This technique allows surgeons to harvest cells from a patient’s own cartilage. The cells are then manipulated using tissue engineering in a laboratory and grown in a culture. In a second procedure, the cells are re-implanted in the knee to repair and resurface areas where there’s been cartilage loss.
This technique allows surgeons to remove a small section of the patient’s own bone and cartilage in an area that does not bear weight to serve as donor cartilage. The donor bone and cartilage is then transferred to the damaged part of the knee being repaired.
For larger areas of bone and cartilage loss, surgeons can implant a piece of freshly donated cartilage and bone that eventually functions as if it were the patient’s own tissue.